=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194516864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMARA INTEGRATIVE HEALTH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 N LAKE SHORE DR STE 110
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 722-538-0128
-----------------------------------------------------
Fax | 773-516-2501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 N LAKE SHORE DR STE 110
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-253-8012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JOEL T MULLER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 504-509-9168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------