| 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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