Healthcare Provider Details

I. General information

NPI: 1598624199
Provider Name (Legal Business Name): ILLUMINATION THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 PLAZA DR
PARMA OH
44130-1043
US

IV. Provider business mailing address

12380 PLAZA DR
PARMA OH
44130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 216-898-8399
  • Fax: 216-898-8455
Mailing address:
  • Phone: 216-898-8399
  • Fax: 216-898-8455

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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMES TAYLOR
Title or Position: CEO
Credential:
Phone: 216-898-8399