NPIMap

Organization Active NPI

Luminous Mind Inc

Doing business as The Luminous Mind

  • Community/Behavioral Health Agency
  • Roseville, MN
National Provider Identifier
1588015168
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
4892 Issued in MN
Legal business name
LUMINOUS MIND INC
Doing business as
The Luminous Mind
Practice address
1611 County Road B W Ste 202
Roseville, MN 55113-4053
Phone
(651) 300-1112
Fax
(651) 358-2996
NPI assigned
Jun 25, 2016
Reactivated
Apr 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Authorized official

Name
Dr. Layla Asamarai, PSYD, LPNPI 1205287885
Title
Owner
Phone
(651) 300-1112

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Adult Development & Aging PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0700X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Health PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0004X
Community/Behavioral Health Agency 251S00000X 4892 MN Primary

Addresses

Primary practice location

1611 County Road B W Ste 202
Roseville, MN 55113-4053

Mailing address

1611 County Road B W Ste 202
Roseville, MN 55113-4053
Phone (651) 300-1112

Other identifiers 1

IdentifierTypeStateIssuer
1588015168MedicaidMN

Other names 1

  • The Luminous Mind Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190520001183 MN Part B Supplier - Clinic/Group Practice 3678816402 Receives reassigned benefits from 10 practitioners
Practice locations: Roseville, MN

National Provider Directory

National Provider Directory

Locations

1611 County Road B W
Ste 218
Roseville, MN 55113
Phone (612) 389-9191

1611 County Road B W
Ste 202
Saint Paul, MN 55113
Phone (651) 300-1112

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1466812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1588015168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 COUNTY ROAD B W STE 202",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134053",
            "telephone_number": "651-300-1112",
            "fax_number": "651-358-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 COUNTY ROAD B W STE 202",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134053",
            "telephone_number": "651-300-1112",
            "fax_number": "651-358-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINOUS MIND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-25",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "deactivation_date": "2017-12-20",
        "reactivation_date": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "ASAMARAI",
        "authorized_official_first_name": "LAYLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-300-1112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "4892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588015168",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Luminous Mind",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.