Organization
LUMINOUS MIND FOUNDATION INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCOS PENA EDD, LCSW, LADAC (CEO)
(575) 332-4070
Entity
Organization
Contact information
Practice address
1301 COUNTRY CLUB RD, SANTA TERESA, NM 88008-9431
(915) 260-8113
(833) 428-3821
Mailing address
1301 COUNTRY CLUB RD, SANTA TERESA, NM 88008-9431
(915) 260-8113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
03/17/2025
Last updated
05/11/2026
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