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General NPI Number Information
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NPI Number | 1336946516
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Entity Type | Organization
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Legal Business Name | ILLUMINATED JOURNEYS, LLC
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1646 E 2ND ST N
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City | WICHITA
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State | KS
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Zip | 67214-4108
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Country | US
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Telephone | 316-202-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 E 2ND ST N
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City | WICHITA
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State | KS
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Zip | 67214-4108
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Country | US
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Telephone | 316-202-8770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIONE BLEU POMPA
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Credential | LCPC
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Telephone | 316-202-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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