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General NPI Number Information
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NPI Number | 1780363465
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Entity Type | Organization
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Legal Business Name | ILLUMINATING PERSPECTIVES COUNSELING & CONSULTATION, LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 13377 LAKE POINT BLVD
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City | VAN BUREN TWP
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State | MI
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Zip | 48111-2288
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Country | US
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Telephone | 716-480-4152
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 HOGBACK RD STE 201
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City | ANN ARBOR
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State | MI
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Zip | 48105-9488
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Country | US
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Telephone | 734-252-6258
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. JAMYE R BANKS
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Credential | PHD
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Telephone | 716-480-4152
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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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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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