Healthcare Provider Details

I. General information

NPI: 1841090925
Provider Name (Legal Business Name): LUMINOUS MIND FOUNDATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 COUNTRY CLUB RD
SANTA TERESA NM
88008-9431
US

IV. Provider business mailing address

1301 COUNTRY CLUB RD
SANTA TERESA NM
88008-9431
US

V. Phone/Fax

Practice location:
  • Phone: 915-260-8113
  • Fax: 833-428-3821
Mailing address:
  • Phone: 915-260-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCOS PENA
Title or Position: CEO
Credential: EDD, LCSW, LADAC
Phone: 915-260-8113