NPIMap

Organization Active NPI

Lumen Pediatric Therapy, LLC

  • Behavior Analyst
  • Saint Clair Shores, MI
National Provider Identifier
1093445900
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
LUMEN PEDIATRIC THERAPY, LLC
Practice address
26210 Harper Ave Ste 200
Saint Clair Shores, MI 48081-2203
Phone
(888) 485-8636
Fax
(586) 218-3367
NPI assigned
Jun 14, 2022
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wayne Kvintus
Title
Chief Executive Officer
Phone
(313) 550-6258

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

26210 Harper Ave Ste 200
Saint Clair Shores, MI 48081-2203

Mailing address

26210 Harper Ave Ste 200
Saint Clair Shores, MI 48081-2203
Phone (888) 485-8636

Other practice location 1

3250 University Dr Ste 110
Auburn Hills, MI 48326-2391
Phone (888) 485-8636

National Provider Directory

National Provider Directory
Tax ID family
Lumen Pediatric Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1093445900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26210 HARPER AVE STE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812203",
            "telephone_number": "888-485-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26210 HARPER AVE STE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812203",
            "telephone_number": "888-485-8636",
            "fax_number": "586-218-3367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3250 University Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Auburn Hills",
            "state": "MI",
            "postal_code": "483262391",
            "country_code": "US",
            "telephone_number": "888-485-8636",
            "fax_number": "586-218-3367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LUMEN PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "KVINTUS",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "313-550-6258"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.