MEDICARE: ILLUMINATE PSYCHOTHERAPY, A MARRIAGE & FAMILY THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1437787603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATE PSYCHOTHERAPY, A MARRIAGE & FAMILY THERAPY INC

Provider Business Mailing Address
First Line	:	5150 E PACIFIC COAST HWY STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3399
Country	:	US
Telephone Number	:	562-310-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E PACIFIC COAST HWY STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3399
Country	:	US
Telephone Number	:	562-999-2317
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISCEL-CATTLEYA NAVARRO SOLIS
Credential	:	LMFT
Telephone Number	:	562-310-8910

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	03/25/2026

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