MEDICARE: LUMEN CORDIS BEHAVIORAL HEALTH, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295333706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN CORDIS BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	931 VILLAGE BLVD STE 905-251
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 HIDDEN HILLS RD APT 1503
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-4826
Country	:	US
Telephone Number	:	954-643-3825
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANA P MARTINEZ
Credential	:
Telephone Number	:	954-643-3825

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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