Provider Demographics
NPI:1033734181
Name:ILLUMINATE THERAPY, LLC
Entity Type:Organization
Organization Name:ILLUMINATE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-790-4514
Mailing Address - Street 1:40 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2438
Mailing Address - Country:US
Mailing Address - Phone:786-436-0671
Mailing Address - Fax:
Practice Address - Street 1:40 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2438
Practice Address - Country:US
Practice Address - Phone:786-436-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty