| Lumina Behavioral Health | |
|
3909 Highway 282 Van Buren AR 72956-8718 | |
| (479) 242-1003 | |
| (501) 510-5917 |
| Full Name | Lumina Behavioral Health |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 3909 Highway 282, Van Buren, Arkansas |
| Authorized Official Name and Position | Dorotha Diane Bynum (OWNER) |
| Authorized Official Contact | 4792421003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lumina Behavioral Health Po Box 7768 Van Buren AR 72956-0741 Ph: (479) 242-1003 | Lumina Behavioral Health 3909 Highway 282 Van Buren AR 72956-8718 Ph: (479) 242-1003 |
| NPI Number | 1154894954 |
|---|---|
| Provider Enumeration Date | 01/04/2019 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 0941603922 |
|---|---|
| Medicare Enrollment ID | O20210728002446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154894954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
| Provider Name | Tisha R Roswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700235728 PECOS PAC ID: 1355673492 Enrollment ID: I20191023000758 |
| Provider Name | Kevin Lavelle Barnett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336408533 PECOS PAC ID: 0840601746 Enrollment ID: I20201125001416 |
| Provider Name | Lorna Shala Macdonald |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972731578 PECOS PAC ID: 4183086721 Enrollment ID: I20230815001601 |
| Provider Name | Amber Joye Callaway |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982922035 PECOS PAC ID: 1850740630 Enrollment ID: I20231213002293 |
| Provider Name | Benjamin Okai |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992039341 PECOS PAC ID: 8224257696 Enrollment ID: I20231221002462 |
| Provider Name | Diane Bynum |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205846706 PECOS PAC ID: 2769885748 Enrollment ID: I20240104003232 |
Wacgc - Crawford Sats Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2705 Oak Ln, Van Buren, AR 72956 Phone: 479-452-6650 Fax: 479-785-9495 | |
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