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General NPI Number Information
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NPI Number | 1003525254
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Entity Type | Organization
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Legal Business Name | THE LUNA THERAPY & WELLNESS CENTER
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 2530 SCOTTSVILLE RD STE 22
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6509
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Country | US
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Telephone | 270-864-6872
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Fax |
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Provider Business Mailing Address
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Address Line | 443 SAINT PAUL AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6586
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Country | US
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Telephone | 270-799-7247
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA L STUNSON
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Credential | LCSW
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Telephone | 270-799-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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