The Luminescent Mind, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE LUMINESCENT MIND, LLC

Practice address

7901 4TH St N Ste 4000
St Petersburg, FL 33702-4305

Phone

(786) 266-0108

NPI assigned

Apr 13, 2023

Last updated

Jun 15, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katheryne Puentes, PH.D., LMHC, LMFTNPI 1205247459

Title

Ceo/Founder/LMHC/LMFT

Phone

(786) 266-0108

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katheryne Puentes

  • Mental Health Counselor
  • St Petersburg, FL
  • NPI 1205247459
  Medicare reassignment NPD Authorized official
• Tara Marie Kellogg

  • Marriage & Family Therapist
  • Fort Lauderdale, FL
  • NPI 1023267416
  Medicare reassignment
• Devon Hallie Yanez, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Coral Springs, FL
  • NPI 1124586631
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1023704947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 4TH ST N STE 4000",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024305",
            "telephone_number": "786-266-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 4TH ST N STE 4000",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024305",
            "telephone_number": "786-266-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LUMINESCENT MIND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "PUENTES",
        "authorized_official_first_name": "KATHERYNE",
        "authorized_official_title_or_position": "CEO/FOUNDER/LMHC/LMFT",
        "authorized_official_telephone_number": "786-266-0108",
        "authorized_official_credential": "PH.D., LMHC, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.