Provider Demographics
NPI:1689138877
Name:ILLUMINATED PATH LLC
Entity Type:Organization
Organization Name:ILLUMINATED PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARITHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-886-0961
Mailing Address - Street 1:PO BOX 82335
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-2335
Mailing Address - Country:US
Mailing Address - Phone:702-886-0961
Mailing Address - Fax:
Practice Address - Street 1:7351 W CHARLESTON BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1572
Practice Address - Country:US
Practice Address - Phone:702-886-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty