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General NPI Number Information
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NPI Number | 1841090925
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Entity Type | Organization
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Legal Business Name | LUMINOUS MIND FOUNDATION INCORPORATED
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1301 COUNTRY CLUB RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9431
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Country | US
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Telephone | 915-260-8113
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Fax | 833-428-3821
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Provider Business Mailing Address
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Address Line | 1301 COUNTRY CLUB RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9431
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Country | US
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Telephone | 915-260-8113
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARCOS PENA
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Credential | EDD, LCSW, LADAC
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Telephone | 915-260-8113
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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