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General NPI Number Information
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NPI Number | 1548141385
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Entity Type | Organization
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Legal Business Name | LUMOS PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 14241 S REDWOOD RD STE 200
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City | BLUFFDALE
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State | UT
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Zip | 84065-5216
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Country | US
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Telephone | 385-342-2808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1270
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City | RIVERTON
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State | UT
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Zip | 84065-1270
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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 | CEO
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Name | JOSH VINEYARD
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Credential |
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Telephone | 801-915-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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