Provider Demographics
NPI:1598398794
Name:ILLUMINATE THERAPY AND WELLNESS, S-CORP
Entity Type:Organization
Organization Name:ILLUMINATE THERAPY AND WELLNESS, S-CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:847-687-7675
Mailing Address - Street 1:1 E NORTHWEST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1700
Mailing Address - Country:US
Mailing Address - Phone:847-908-8700
Mailing Address - Fax:847-907-9780
Practice Address - Street 1:1 E NORTHWEST HWY STE 201
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1700
Practice Address - Country:US
Practice Address - Phone:847-908-8700
Practice Address - Fax:847-907-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty