Provider Demographics
NPI:1477239861
Name:LUMOS THERAPY LLC
Entity Type:Organization
Organization Name:LUMOS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARING
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-765-8159
Mailing Address - Street 1:707 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2310
Mailing Address - Country:US
Mailing Address - Phone:217-765-8159
Mailing Address - Fax:
Practice Address - Street 1:707 22ND ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2310
Practice Address - Country:US
Practice Address - Phone:217-765-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty