Organization Name: | ILLUMINATE CHRISTIAN COUNSELING, LLC |
NPI Number: | 1811375108 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRITTANY COLEMAN (PRESIDENT) |
Mailing Address: | 19115 Fm 2252 Ste. 12 Garden Ridge |
State: | TX US |
Postal Code: | 782662577 |
Phone Number: | 2108457949 |
Fax Number: | 2105452504 |
NPI Enumeration Date: | 05/07/2015 |
NPI Last Update Date: | 05/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 63769 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |