Healthcare Provider Details

I. General information

NPI: 1457098162
Provider Name (Legal Business Name): LUMEN THERAPEUTIC SERVICES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54633 SALEM DR
SHELBY TOWNSHIP MI
48316-1374
US

IV. Provider business mailing address

54633 SALEM DR
SHELBY TOWNSHIP MI
48316-1374
US

V. Phone/Fax

Practice location:
  • Phone: 586-804-1245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NOOR AL-OMARI
Title or Position: SOCIAL WORKER
Credential: LMSW
Phone: 586-804-1245