Provider Demographics
NPI:1588015168
Name:LUMINOUS MIND INC
Entity Type:Organization
Organization Name:LUMINOUS MIND INC
Other - Org Name:THE LUMINOUS MIND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAMARAI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:651-300-1112
Mailing Address - Street 1:1611 COUNTY ROAD B W STE 202
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4053
Mailing Address - Country:US
Mailing Address - Phone:651-300-1112
Mailing Address - Fax:651-358-2996
Practice Address - Street 1:1611 COUNTY ROAD B W STE 202
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4053
Practice Address - Country:US
Practice Address - Phone:651-300-1112
Practice Address - Fax:651-358-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-25
Last Update Date:2020-01-29
Deactivation Date:2017-12-20
Deactivation Code:
Reactivation Date:2019-04-04
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TA0700X, 103TC0700X, 103TH0004X
MN4892251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1588015168Medicaid