Healthcare Provider Details

I. General information

NPI: 1598398794
Provider Name (Legal Business Name): ILLUMINATE THERAPY AND WELLNESS, S-CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2020
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E NORTHWEST HWY STE 201
PALATINE IL
60067-1700
US

IV. Provider business mailing address

1 E NORTHWEST HWY STE 201
PALATINE IL
60067-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-908-8700
  • Fax: 847-907-9780
Mailing address:
  • Phone: 847-908-8700
  • Fax: 847-907-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRETA NIELSEN
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCPC, NCC
Phone: 847-687-7675