Healthcare Provider Details

I. General information

NPI: 1902602733
Provider Name (Legal Business Name): LUMA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 EASTSIDE DRIVE
FOX AK
99707
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: 401-855-4776
  • 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: PAUL GAINES
Title or Position: AUTHORIZED OFFICIAL
Credential: LICSW
Phone: 401-855-4776