Provider Demographics
NPI:1720350333
Name:LUMINOSITY
Entity Type:Organization
Organization Name:LUMINOSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SURBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-650-6214
Mailing Address - Street 1:301 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NE
Mailing Address - Zip Code:68728-2841
Mailing Address - Country:US
Mailing Address - Phone:402-650-6214
Mailing Address - Fax:
Practice Address - Street 1:301 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NE
Practice Address - Zip Code:68728-2841
Practice Address - Country:US
Practice Address - Phone:402-650-6214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025530800Medicaid