NPIMap

Organization Active NPI

Illuminate Mental Health LLC

  • Mental Health Counselor
  • Appleton, WI
National Provider Identifier
1083436067
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ILLUMINATE MENTAL HEALTH LLC
Practice address
626 E Longview Dr Lowr Level
Appleton, WI 54911-2130
Phone
(920) 215-2260
NPI assigned
Oct 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Dedra M Buteyn, LPCNPI 1104689736
Title
Owner
Phone
(920) 215-2260

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

626 E Longview Dr Lowr Level
Appleton, WI 54911-2130

Mailing address

626 E Longview Dr Lowr Level
Appleton, WI 54911-2130
Phone (920) 215-2260

National Provider Directory

National Provider Directory

Locations

626 E Longview Dr
Lowr
Appleton, WI 54911
Phone (920) 215-2260

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1083436067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 E LONGVIEW DR LOWR LEVEL",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112130",
            "telephone_number": "920-215-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 E LONGVIEW DR LOWR LEVEL",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112130",
            "telephone_number": "920-215-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "BUTEYN",
        "authorized_official_first_name": "DEDRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-215-2260",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.