Organization
LUMINOUS ORIGINS THERAPY AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA LEBARON (OWNER)
(763) 443-7620
Entity
Organization
Contact information
Practice address
11310 134TH AVE N, DAYTON, MN 55327-9741
(763) 443-7620
Mailing address
11310 134TH AVE N, DAYTON, MN 55327-9741
(763) 443-7620
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/26/2025
Last updated
03/26/2025
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