Provider Demographics
NPI:1467344374
Name:LUNA BLANCO, JAVIER DARIO (LPC)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:DARIO
Last Name:LUNA BLANCO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-3310
Mailing Address - Country:US
Mailing Address - Phone:262-822-2285
Mailing Address - Fax:
Practice Address - Street 1:4006 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4819
Practice Address - Country:US
Practice Address - Phone:262-771-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11855-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional