Provider Demographics
NPI:1962119685
Name:LUMINA THERAPY LLC
Entity type:Organization
Organization Name:LUMINA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:818-844-1391
Mailing Address - Street 1:10955 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9035
Mailing Address - Country:US
Mailing Address - Phone:810-844-1391
Mailing Address - Fax:
Practice Address - Street 1:711 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2474
Practice Address - Country:US
Practice Address - Phone:810-844-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)