NPIMap

Organization Active NPI

Lumen Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Saint Clair Shores, MI
National Provider Identifier
1407573942
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
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
Oct 25, 2022
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Nicholle Mehr
Title
Chief Executive Officer
Phone
(888) 485-8636

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary
Behavior Analyst 103K00000X NU

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230317000382 MI Part B Supplier - Clinic/Group Practice 8628442407 Receives reassigned benefits from 2 practitioners
Practice locations: Auburn Hills, MI; Saint Clair Shores, MI

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.

Locations

3250 University Dr
Ste 110
Auburn Hills, MI 48326
Phone (888) 456-8636

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1407573942",
    "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": "2022-10-25",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "MEHR",
        "authorized_official_first_name": "NICHOLLE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "888-485-8636"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "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 Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.