Provider Demographics
NPI:1689388118
Name:LUMINARY TRANSITIONS
Entity Type:Organization
Organization Name:LUMINARY TRANSITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERTATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-528-5258
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0025
Mailing Address - Country:US
Mailing Address - Phone:573-528-5258
Mailing Address - Fax:
Practice Address - Street 1:407 4TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:573-528-5258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty