Provider Demographics
NPI:1124883160
Name:LUMIERE LLC
Entity type:Organization
Organization Name:LUMIERE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:OPOLLO
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-602-2620
Mailing Address - Street 1:6715 NE 63RD ST STE 277
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:360-602-2620
Mailing Address - Fax:
Practice Address - Street 1:9120 NE VANCOUVER MALL LOOP STE 262
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6391
Practice Address - Country:US
Practice Address - Phone:541-702-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty