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General NPI Number Information
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NPI Number | 1053294017
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Entity Type | Organization
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Legal Business Name | LUMINA MIND AND WELLNESS INC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 14441 W MCDOWELL RD STE B102
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City | GOODYEAR
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State | AZ
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Zip | 85395-2519
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Country | US
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Telephone | 602-763-8652
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Fax |
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Provider Business Mailing Address
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Address Line | 20044 N 68TH DR
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City | GLENDALE
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State | AZ
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Zip | 85308-5594
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Country | US
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Telephone | 602-763-8652
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAURA M ROSS
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Credential | PMHNP-BC
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Telephone | 602-763-8652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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