Healthcare Provider Details

I. General information

NPI: 1992058184
Provider Name (Legal Business Name): THE LUMINARIES PROJECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NICHOLS RD STE 200
KANSAS CITY MO
64112-2036
US

IV. Provider business mailing address

PO BOX 901348
KANSAS CITY MO
64190-1348
US

V. Phone/Fax

Practice location:
  • Phone: 816-368-2000
  • Fax:
Mailing address:
  • Phone: 816-368-2000
  • Fax: 816-533-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA AGUDELO BENITO
Title or Position: OWNER
Credential: DSW, LCSW
Phone: 347-418-2991