Provider Demographics
NPI:1457098162
Name:LUMEN THERAPEUTIC SERVICES, P.L.L.C.
Entity type:Organization
Organization Name:LUMEN THERAPEUTIC SERVICES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-OMARI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-804-1245
Mailing Address - Street 1:54633 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54633 SALEM DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1374
Practice Address - Country:US
Practice Address - Phone:586-804-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)