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General NPI Number Information
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NPI Number | 1346961919
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Entity Type | Organization
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Legal Business Name | ILLUMINATE COUNSELING LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 3408 WOODLAND AVE STE 209
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City | WEST DES MOINES
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State | IA
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Zip | 50266-6506
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Country | US
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Telephone | 515-305-2380
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Fax | 515-517-6114
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Provider Business Mailing Address
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Address Line | 3408 WOODLAND AVE STE 209
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City | WEST DES MOINES
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State | IA
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Zip | 50266-6506
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Country | US
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Telephone | 515-305-2380
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Fax | 515-517-6114
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MISS MEGAN HALLIE CECIL
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Credential | LMHC, CADC
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Telephone | 515-305-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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