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General NPI Number Information
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NPI Number | 1861389850
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Entity Type | Organization
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Legal Business Name | NUMINOUS PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 06/21/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 27000 N HIGHWAY 1
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City | FORT BRAGG
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State | CA
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Zip | 95437-8900
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Country | US
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Telephone | 530-310-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 326 I ST UNIT 108
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City | EUREKA
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State | CA
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Zip | 95501-0522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | ASHLEY TAGGART KRUEGER
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Credential |
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Telephone | 209-227-4914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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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 | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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