Provider Demographics
NPI:1194518779
Name:LUNA, DALLIS (MA)
Entity type:Individual
Prefix:MRS
First Name:DALLIS
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DALLIS
Other - Middle Name:
Other - Last Name:WESTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:429 1/2 W BELDEN AVE APT B208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7853
Mailing Address - Country:US
Mailing Address - Phone:773-322-6629
Mailing Address - Fax:
Practice Address - Street 1:429 1/2 W BELDEN AVE APT B208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7853
Practice Address - Country:US
Practice Address - Phone:773-322-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health