Provider Demographics
NPI:1770972531
Name:LUMOS WELLNESS, LLC
Entity type:Organization
Organization Name:LUMOS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR, ART THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:L'ESPERANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DAT, ATR-BC, LPC
Authorized Official - Phone:920-379-2566
Mailing Address - Street 1:325 W SILVER SPRING DR # 2FE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5000
Mailing Address - Country:US
Mailing Address - Phone:920-379-2566
Mailing Address - Fax:
Practice Address - Street 1:325 W SILVER SPRING DR # 2FE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5000
Practice Address - Country:US
Practice Address - Phone:920-379-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4921251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health