| The Luminous Mind | |
|
1611 County Road B W Ste 202 Roseville MN 55113-4053 | |
| (651) 300-1112 | |
| (651) 358-2996 |
| Full Name | The Luminous Mind |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1611 County Road B W Ste 202, Roseville, Minnesota |
| Authorized Official Name and Position | Layla Asamarai (OWNER) |
| Authorized Official Contact | 6513001112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Luminous Mind 1611 County Road B W Ste 202 Roseville MN 55113-4053 Ph: (651) 300-1112 | The Luminous Mind 1611 County Road B W Ste 202 Roseville MN 55113-4053 Ph: (651) 300-1112 |
| NPI Number | 1588015168 |
|---|---|
| Provider Enumeration Date | 06/25/2016 |
| Last Update Date | 01/29/2020 |
| Certification Date | 01/29/2020 |
| Medicare PECOS PAC ID | 3678816402 |
|---|---|
| Medicare Enrollment ID | O20190520001183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588015168 | NPI | - | NPPES |
| 1588015168 | Medicaid | MN |
| Provider Name | Layla A Asamarai |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205287885 PECOS PAC ID: 9032497672 Enrollment ID: I20161102000016 |
| Provider Name | Kelsey J Mccarston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518439702 PECOS PAC ID: 1254679699 Enrollment ID: I20190211002507 |
| Provider Name | Ruth Marie Swartwood |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992179501 PECOS PAC ID: 6709289051 Enrollment ID: I20210723000578 |
| Provider Name | Gregory R Simonson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942850003 PECOS PAC ID: 5799163713 Enrollment ID: I20220603001306 |
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