Healthcare Provider Details

I. General information

NPI: 1649076456
Provider Name (Legal Business Name): LUMINOUS MIND INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

633 W 5TH ST STE 2600
LOS ANGELES CA
90071-2053
US

IV. Provider business mailing address

633 W 5TH ST STE 2600
LOS ANGELES CA
90071-2053
US

V. Phone/Fax

Practice location:
  • Phone: 213-461-0848
  • Fax:
Mailing address:
  • Phone: 213-461-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: YINLING SUN
Title or Position: CEO
Credential: LMFT
Phone: 213-631-6264