| Organization Name: | LUNA DE COBRE THERAPY CENTER, LLC |
| NPI Number: | 1184949422 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARITA SILVA POTTS (REGISTERED AGENT) |
| Mailing Address: | 807 Grant St. Bayard |
| State: | NM US |
| Postal Code: | 88023 |
| Phone Number: | 5755902202 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2010 |
| NPI Last Update Date: | 03/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0101621 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |