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General NPI Number Information
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NPI Number | 1720350333
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Entity Type | Organization
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Legal Business Name | LUMINOSITY
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 301 BROADWAY ST
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City | CONCORD
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State | NE
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Zip | 68728-2841
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Country | US
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Telephone | 402-650-6214
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Fax |
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Provider Business Mailing Address
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Address Line | 301 BROADWAY ST
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City | CONCORD
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State | NE
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Zip | 68728-2841
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Country | US
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Telephone | 402-650-6214
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRENDA RAE SURBER
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Credential | LMHP
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Telephone | 402-650-6214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3071
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License Number State | NE
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