Organization
LA LUNA CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM CRISCO (BUSINESS MANAGER)
(720) 470-0010
Entity
Organization
Contact information
Practice address
3002 BLUFF ST, SUITE 200, BOULDER, CO 80301-2162
(720) 470-0010
(303) 200-7098
Mailing address
3002 BLUFF ST, SUITE 200, BOULDER, CO 80301-2162
(720) 470-0010
(303) 200-7098
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Enumeration date
03/23/2007
Last updated
12/17/2020
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