Provider Demographics
NPI:1982258026
Name:ILLUMINATA COUNSELING
Entity Type:Organization
Organization Name:ILLUMINATA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-871-2830
Mailing Address - Street 1:65 HALILI LN APT 10
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6079
Mailing Address - Country:US
Mailing Address - Phone:808-280-4402
Mailing Address - Fax:
Practice Address - Street 1:135 S WAKEA AVE STE 208
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1385
Practice Address - Country:US
Practice Address - Phone:808-871-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty