Provider Demographics
NPI:1972366755
Name:ILLUMINATED COUNSELING, PLLC
Entity Type:Organization
Organization Name:ILLUMINATED COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGOZICHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-551-6515
Mailing Address - Street 1:13220 S 48TH ST APT 1130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13220 S 48TH ST APT 1130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5099
Practice Address - Country:US
Practice Address - Phone:602-551-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health