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General NPI Number Information
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NPI Number | 1508415407
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Entity Type | Organization
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Legal Business Name | ILLUMINATE COUNSELING SERVICES, P.C.
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 1220 IROQUOIS AVE STE 204A
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City | NAPERVILLE
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State | IL
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Zip | 60563-8574
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Country | US
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Telephone | 630-854-2320
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 SWALLOW ST
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City | NAPERVILLE
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State | IL
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Zip | 60565-2332
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Country | US
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Telephone | 630-854-2320
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER PSYCHOTHERAPIST
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Name | MS. ANDREA C CANLAS
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Credential | LCPC
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Telephone | 630-854-2320
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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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