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General NPI Number Information
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NPI Number | 1457190126
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Entity Type | Organization
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Legal Business Name | LUMOS MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 10151 DEERWOOD PARK BLVD BLDG 200
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0566
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Country | US
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Telephone | 904-906-6754
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Fax |
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Provider Business Mailing Address
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Address Line | 7643 GATE PKWY STE 104-1381
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3092
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Country | US
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Telephone | 904-906-6754
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE MARGARITA SMITH
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Credential | LMHC
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Telephone | 904-322-1232
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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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