Healthcare Provider Details

I. General information

NPI: 1194374819
Provider Name (Legal Business Name): LUMINATIONS HEALING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 S. VAL VISTA DR. #221
MESA AZ
85204
US

IV. Provider business mailing address

1237 S. VAL VISTA DR. #221
MESA AZ
85204
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-3391
  • Fax:
Mailing address:
  • Phone: 480-776-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ARIEL ANN SCHULZ
Title or Position: CO-MEMBER
Credential: LCSW
Phone: 480-215-5957