MEDICARE: LUMINA INTEGRATIVE PSYCHIATRY 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1710818018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINA INTEGRATIVE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	2023 BAY POINTE DR
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-6106
Country	:	US
Telephone Number	:	413-297-2717
Fax Number	:

Provider Business Practice Location Address
First Line	:	2023 BAY POINTE DR
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-6106
Country	:	US
Telephone Number	:	413-297-2717
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA SCOLA
Credential	:
Telephone Number	:	413-297-2717

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	06/02/2026

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