Provider Demographics
NPI:1003594698
Name:LUMINOUS PSYCHIATRY AND THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:LUMINOUS PSYCHIATRY AND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:912-484-6459
Mailing Address - Street 1:7805 WATERS AVE # 7A-4
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2441
Mailing Address - Country:US
Mailing Address - Phone:888-462-1601
Mailing Address - Fax:
Practice Address - Street 1:7805 WATERS AVE # 7A-4
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2441
Practice Address - Country:US
Practice Address - Phone:888-462-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)