Provider Demographics
NPI:1497337489
Name:LUNA, SANTIAGO LUIS
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:LUIS
Last Name:LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11844 BANDERA RD # 201
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4132
Mailing Address - Country:US
Mailing Address - Phone:210-319-9807
Mailing Address - Fax:
Practice Address - Street 1:6821 N COUNTRY HOMES BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4376
Practice Address - Country:US
Practice Address - Phone:509-558-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-134369106S00000X
WAMC61647914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician