Provider Demographics
NPI:1912673732
Name:LUMINESCENCE COUNSELING LLC
Entity Type:Organization
Organization Name:LUMINESCENCE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:541-912-6842
Mailing Address - Street 1:1110 W 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2235
Mailing Address - Country:US
Mailing Address - Phone:541-912-6842
Mailing Address - Fax:541-229-1263
Practice Address - Street 1:1390 OAK ST STE 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3567
Practice Address - Country:US
Practice Address - Phone:541-912-6842
Practice Address - Fax:541-229-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty