Healthcare Provider Details

I. General information

NPI: 1104621424
Provider Name (Legal Business Name): LUMA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 OLD WOOD ROAD SUITE 74915
ESTER AK
99709
US

IV. Provider business mailing address

315 BARNETTE ST UNIT 74915
FAIRBANKS AK
99707-1157
US

V. Phone/Fax

Practice location:
  • Phone: 401-855-4776
  • Fax:
Mailing address:
  • Phone: 401-855-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PAUL L GAINES JR.
Title or Position: OWNER / CEO
Credential: L.I.C.S.W.
Phone: 401-855-4776