Provider Demographics
NPI:1982190633
Name:ILLUMINATE PSYCHOLOGICAL ASSESSMENTS, LLC
Entity Type:Organization
Organization Name:ILLUMINATE PSYCHOLOGICAL ASSESSMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-857-6393
Mailing Address - Street 1:3330 OLD GLENVIEW RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2963
Mailing Address - Country:US
Mailing Address - Phone:312-857-6393
Mailing Address - Fax:
Practice Address - Street 1:3330 OLD GLENVIEW RD STE 10
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:312-857-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty