Provider Demographics
NPI:1518588441
Name:GLORIA M ESQUIVEL-LYNCH LLC
Entity Type:Organization
Organization Name:GLORIA M ESQUIVEL-LYNCH LLC
Other - Org Name:LUNA WELLNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ESQUIVEL-LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-739-7002
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 HAMILTON RD STE 4
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1156
Practice Address - Country:US
Practice Address - Phone:419-739-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)