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General NPI Number Information
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NPI Number | 1295333706
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Entity Type | Organization
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Legal Business Name | LUMEN CORDIS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 2936 HIDDEN HILLS RD APT 1503
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-4826
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Country | US
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Telephone | 954-643-3825
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Fax |
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Provider Business Mailing Address
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Address Line | 931 VILLAGE BLVD STE 905-251
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1803
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANA P MARTINEZ
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Credential |
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Telephone | 954-643-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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