Healthcare Provider Details

I. General information

NPI: 1154255404
Provider Name (Legal Business Name): LUMAMIND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W PALMETTO PARK RD STE 410
BOCA RATON FL
33486-3325
US

IV. Provider business mailing address

2139 N UNIVERSITY DR STE 2256
CORAL SPRINGS FL
33071-6134
US

V. Phone/Fax

Practice location:
  • Phone: 561-606-3732
  • Fax:
Mailing address:
  • Phone: 561-606-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FARAH PHILIPPE
Title or Position: MANAGING MEMBER
Credential: FNP-BC PMHNP
Phone: 410-807-2372