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General NPI Number Information
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NPI Number | 1669327938
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Entity Type | Organization
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Legal Business Name | ILLUMINATED SELF THERAPY SERVICES LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1329 E KEMPER RD STE 4212B
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City | SPRINGDALE
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State | OH
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Zip | 45246-5100
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Country | US
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Telephone | 513-283-0004
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Fax | 513-832-0499
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Provider Business Mailing Address
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Address Line | 1329 E KEMPER RD STE 4212B
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City | SPRINGDALE
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State | OH
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Zip | 45246-5100
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Country | US
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Telephone | 513-283-0004
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Fax | 513-832-0499
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | NIKI KENLEY
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Credential | LPCC
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Telephone | 417-848-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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