Provider Demographics
NPI:1821769621
Name:STELLA LUNA THERAPY, LLC
Entity Type:Organization
Organization Name:STELLA LUNA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGIANDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:440-879-8517
Mailing Address - Street 1:13550 FALLING WATER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-4360
Mailing Address - Country:US
Mailing Address - Phone:440-879-8517
Mailing Address - Fax:
Practice Address - Street 1:13550 FALLING WATER RD STE 108
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4360
Practice Address - Country:US
Practice Address - Phone:440-879-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STELLA LUNA THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty