Provider Demographics
NPI:1265299762
Name:LUMINOSITY MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:LUMINOSITY MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:VAHOVIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:334-546-2973
Mailing Address - Street 1:6630 ASHMORE LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0308
Mailing Address - Country:US
Mailing Address - Phone:903-581-6885
Mailing Address - Fax:903-581-1081
Practice Address - Street 1:2961 ELKTON TRAIL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0308
Practice Address - Country:US
Practice Address - Phone:903-581-6885
Practice Address - Fax:903-581-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty