ILLUMINATE THERAPY LLC (NPI# 1194367953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194367953 |
| Entity Type | Organization |
| Organization Name | ILLUMINATE THERAPY LLC |
| Practice Address |
234 W Caroline St Ste 3 Fenton MI 48430-2807 |
| Practice Telephone | 5179749353 |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |
| Authorized Official Name | AMY THOMPSON (OWNER) |
| Authorized Official Telephone | 5179749353 |
| Authorized Official Credential | MA LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1306242623 | 05 |
| Other Name | Type Code |
|---|---|
| Illuminate Therapy | Doing Business As Name - Organization |
| Street Address |
234 W CAROLINE ST STE 3 |
| City | FENTON |
| State | MI |
| Zip Code | 48430-2807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225647514 | Drs Mesh, P.C. | Dentist | 15555 Silver Parkway, Fenton, MI 48430 | 2020-07-23 |
| 1225515091 | Erica Anderson | Social Worker | 127 River St., Fenton, MI 48430 | 2018-07-25 |
| 1245767888 | Optimum Balance | Clinic/Center | 1537 N. Leroy Street, Suite D, Fenton, MI 48430 | 2017-05-14 |
| 1710411293 | Abdul Hassan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11 Chateaux Du Lac, Fenton, MI 48430 | 2017-04-12 |
| 1366994410 | Intentional Wellbeing LLC | Psychologist | 1122 N. Leroy Rd, Suite A, Fenton, MI 48430 | 2016-10-25 |
| 1265801625 | Shawn Marie Gorkiewicz | Nurse Practitioner | 435 North Leroy, Fenton, MI 48430 | 2015-09-16 |
| 1972994226 | Carrie Hamilton | Physical Medicine & Rehabilitation | 102 N Adelaide St Ste B, Fenton, MI 48430 | 2015-02-09 |
| 1104222520 | Wellbridge of Fenton, LLC | Skilled Nursing Facility | 901 Pine Creek Drive, Fenton, MI 48430 | 2014-11-12 |
| 1225442759 | Joseph Matthew Leppek | Optometrist | 1425 N. Leroy St., Fenton, MI 48430 | 2014-06-12 |
| 1437569647 | Therapy Support Center LLC | Clinic/Center | 113 North River Street, Fenton, MI 48430 | 2014-04-28 |
| Find all providers in zip 48430 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982167177 | Ashley Menard | Counselor | 1091 Fenton Park Dr, Fenton, MO 63026-7614 | 2019-04-13 |
| 1669946430 | Kimberly Gruber | Counselor | 110 Trealout Dr Ste 104, Fenton, MI 48430-3211 | 2019-01-15 |
| 1376057729 | Kimberly Ann Cardeccia | Counselor | 7601 E Allen Rd, Fenton, MI 48430-9221 | 2017-11-21 |
| 1699134817 | Victoria Milligan-cox | Counselor | 1013 Winter Park Dr, Fenton, MO 63026-5690 | 2016-02-16 |
| 1104198332 | Jennifer Monique Prestenbach | Counselor | 735 Woodbine Dr, Fenton, MI 48430-1422 | 2012-02-03 |
| 1851619308 | Sandra Ann Davis | Counselor | 216 Copper Mountain Dr, Fenton, MO 63026-5679 | 2010-05-07 |
| 1477749174 | Denise M Urban | Counselor | 1100 Torrey Rd Ste 100, Fenton, MI 48430-3327 | 2007-09-18 |
| 1205962123 | Amy D Burlison | Counselor | Mobile Counseling Services, 1039 Acorn Hollow Court, Fenton, MO 63026 | 2007-02-26 |
| 1881203651 | Linda Barbara Spaine | Counselor | 110 Trealout Dr Ste 104, Fenton, MI 48430-3211 | 2020-07-28 |
| 1376199257 | Neil Vincent Bedell | Counselor | 110 Trealout Dr Ste 104, Fenton, MI 48430-3211 | 2019-08-15 |
| Find all providers in FENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.