Healthcare Provider Details

I. General information

NPI: 1205772050
Provider Name (Legal Business Name): LUX MENTIS BEHAVIORAL CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30740 STATE ROAD 54 STE 151
WESLEY CHAPEL FL
33543-6009
US

IV. Provider business mailing address

30740 STATE ROAD 54 STE 151
WESLEY CHAPEL FL
33543-6009
US

V. Phone/Fax

Practice location:
  • Phone: 813-331-5523
  • Fax:
Mailing address:
  • Phone: 813-331-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CORTES
Title or Position: MANAGER
Credential: BCBA
Phone: 813-331-5523