Provider Demographics
NPI:1285479360
Name:LUMOS THERAPY, PLLC
Entity type:Organization
Organization Name:LUMOS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-544-9613
Mailing Address - Street 1:1062 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1062 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-2800
Practice Address - Country:US
Practice Address - Phone:630-544-9613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty