MEDICARE: LUMEN GUIDANCE & CONSULTATION, 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	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992459119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN GUIDANCE & CONSULTATION, LLC

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY
Second Line	:	BLDG 100 - STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30327-2886
Country	:	US
Telephone Number	:	770-415-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY
Second Line	:	BLDG 100 - STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30327-2886
Country	:	US
Telephone Number	:	770-415-5446
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KATHERINE E HALE
Credential	:	PHD
Telephone Number	:	770-415-5446

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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