MEDICARE: ILLUMINATE COUNSELING AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1861249971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATE COUNSELING AND WELLNESS

Provider Business Mailing Address
First Line	:	801 N NEGLEY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-1560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N NEGLEY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-1560
Country	:	US
Telephone Number	:	412-925-7111
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/OWNER
Name	:	LAURA JONES
Credential	:
Telephone Number	:	412-925-7111

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/07/2024

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