MEDICARE: LUCERNA BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1184570723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCERNA BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	246 COLUMBIA CLUB DR E
Second Line	:
City	:	BLYTHEWOOD
State	:	SC
Zip	:	29016-9479
Country	:	US
Telephone Number	:	803-240-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 FOREST DR STE A205
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4146
Country	:	US
Telephone Number	:	803-866-6656
Fax Number	:	803-805-6115

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL JOSEPH RUGULEISKI
Credential	:	LPC
Telephone Number	:	803-240-1967

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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