Provider Demographics
NPI:1285312355
Name:LUMEL MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LUMEL MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:KWENTUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-803-7593
Mailing Address - Street 1:14219 CALICE ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5972
Mailing Address - Country:US
Mailing Address - Phone:225-803-7593
Mailing Address - Fax:
Practice Address - Street 1:5023 FRONT ROYAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-2324
Practice Address - Country:US
Practice Address - Phone:225-803-7593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty