Provider Demographics
NPI:1023728631
Name:ILLUMINATE COUNSELING AND COACHING
Entity type:Organization
Organization Name:ILLUMINATE COUNSELING AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-578-1535
Mailing Address - Street 1:2291 CABALLO AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5657
Mailing Address - Country:US
Mailing Address - Phone:406-587-1535
Mailing Address - Fax:
Practice Address - Street 1:2291 CABALLO AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5657
Practice Address - Country:US
Practice Address - Phone:406-587-1535
Practice Address - Fax:406-303-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty