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General NPI Number Information
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NPI Number | 1720716723
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Entity Type | Organization
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Legal Business Name | LUMEN MENTAL HEALTH
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 5080 BRADENTON AVE STE D
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City | DUBLIN
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State | OH
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Zip | 43017-7581
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Country | US
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Telephone | 614-367-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 2267 SATTERBURY CT
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City | DUBLIN
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State | OH
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Zip | 43016-9599
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Country | US
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Telephone | 857-998-1782
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN VERLAGE
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Credential | MD
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Telephone | 857-998-1782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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