Provider Demographics
NPI:1861977506
Name:LUMINOSITY INC
Entity type:Organization
Organization Name:LUMINOSITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CADC
Authorized Official - Phone:712-320-0202
Mailing Address - Street 1:1451 210TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7566
Mailing Address - Country:US
Mailing Address - Phone:712-320-0202
Mailing Address - Fax:
Practice Address - Street 1:605 LAKE ST STE 5
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1674
Practice Address - Country:US
Practice Address - Phone:712-320-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)