Luminous Origins Therapy and Wellness LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LUMINOUS ORIGINS THERAPY AND WELLNESS LLC

Practice address

11310 134TH Ave N
Dayton, MN 55327-9741

Phone

(763) 443-7620

NPI assigned

Mar 26, 2025

Last updated

Mar 26, 2025By 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

Tara LebaronNPI 1124490453

Title

Owner

Phone

(763) 443-7620

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Tara Lebaron, LPCC

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1124490453
  NPD Authorized official

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

{
    "created_epoch": "1742947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1396547667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11310 134TH AVE N",
            "city": "DAYTON",
            "state": "MN",
            "postal_code": "553279741",
            "telephone_number": "763-443-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11310 134TH AVE N",
            "city": "DAYTON",
            "state": "MN",
            "postal_code": "553279741",
            "telephone_number": "763-443-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINOUS ORIGINS THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-26",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "LEBARON",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-443-7620"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cecile Nono Ketchaya
• Niloo Shanya Krueger, MD
• Lacie Peterson Speech and Language LLC
• Gavin Lamott
• Blake Christopher Loxtercamp, DC, MS, CSCS
• Magnus Veterans Foundation
• Agnes Adwoa Mensah
• Ronald N Omari, CNP
• Lauren Pederson
• Lacie Peterson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Dayton, MN
• Providers in Dayton, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.