Illumination Psychotherapy, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ILLUMINATION PSYCHOTHERAPY, PLLC

Practice address

7300 N Cicero Ave Ste 102a
Lincolnwood, IL 60712-1641

Phone

(773) 318-7304

NPI assigned

Jan 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Garrett Shotwell, LCSW

Title

Owner, Ceo

Phone

(773) 318-7304

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Milana Pehar, LCPC

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1487363412
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1013557644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 N CICERO AVE STE 102A",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121641",
            "telephone_number": "773-318-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 N CICERO AVE STE 102A",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121641",
            "telephone_number": "773-318-7304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5557 1/2 N Magnolia Ave Apt 3E",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606401334",
            "country_code": "US",
            "telephone_number": "773-318-7304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILLUMINATION PSYCHOTHERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-11",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "SHOTWELL",
        "authorized_official_first_name": "GARRETT",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "773-318-7304",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Lincolnwood, IL
• Providers in Lincolnwood, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.