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General NPI Number Information
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NPI Number | 1033734181
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Entity Type | Organization
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Legal Business Name | ILLUMINATE THERAPY, LLC
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 40 FLORIDA BLVD
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City | MIAMI
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State | FL
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Zip | 33144-2438
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Country | US
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Telephone | 786-436-0671
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Fax |
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Provider Business Mailing Address
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Address Line | 40 FLORIDA BLVD
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City | MIAMI
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State | FL
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Zip | 33144-2438
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Country | US
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Telephone | 786-436-0671
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Fax |
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Authorized Official
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Title or Position | OWNER AND BCBA
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Name | KRISTINA A VINAS
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Credential | BCBA
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Telephone | 305-790-4514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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