Lumos | |
131 S Main St Ste M05 Fond Du Lac WI 54935-4386 | |
(920) 659-5414 | |
Not Available |
Full Name | Lumos |
---|---|
Speciality | Counselor - Mental Health |
Location | 131 S Main St Ste M05, Fond Du Lac, Wisconsin |
Authorized Official Name and Position | Kaitlyn Kenealy (OWNER) |
Authorized Official Contact | 6127906230 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Lumos 131 S Main St Ste M05 Fond Du Lac WI 54935-4386 Ph: () - | Lumos 131 S Main St Ste M05 Fond Du Lac WI 54935-4386 Ph: (920) 659-5414 |
NPI Number | 1376301382 |
---|---|
Provider Enumeration Date | 03/13/2024 |
Last Update Date | 03/13/2024 |
Certification Date | 03/13/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376301382 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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