Healthcare Provider Details

I. General information

NPI: 1841134517
Provider Name (Legal Business Name): LUMEN TELEPSYCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW LEARY WAY STE 400
SEATTLE WA
98107-5138
US

IV. Provider business mailing address

2459 BAKER RD
GOODLETTSVILLE TN
37072-9553
US

V. Phone/Fax

Practice location:
  • Phone: 360-503-5973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA JOHNSON
Title or Position: OWNER
Credential: PMHNP
Phone: 360-503-5973