Provider Demographics
NPI:1508415407
Name:ILLUMINATE COUNSELING SERVICES, P.C.
Entity Type:Organization
Organization Name:ILLUMINATE COUNSELING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-854-2320
Mailing Address - Street 1:1640 SWALLOW ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2332
Mailing Address - Country:US
Mailing Address - Phone:630-854-2320
Mailing Address - Fax:
Practice Address - Street 1:1220 IROQUOIS AVE STE 204A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8574
Practice Address - Country:US
Practice Address - Phone:630-854-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty