Illumination, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

2150 Issued in MN

Legal business name

ILLUMINATION, LLC

Practice address

1660 Highway 100 S
Suite 502
St Louis Park, MN 55416-1529

Phone

(612) 239-6017

NPI assigned

Feb 19, 2014

Organization subpart

No

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

Authorized official

Name

Miss Sarah Gravelle Thoeny, MS LMFT

Title

Owner

Phone

(612) 239-6017

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392768000000",
    "number": "1194140749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S",
            "address_2": "SUITE 502",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161529",
            "telephone_number": "612-239-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S",
            "address_2": "SUITE 502",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161529",
            "telephone_number": "612-239-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-19",
        "last_updated": "2014-02-19",
        "status": "A",
        "authorized_official_last_name": "THOENY",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "GRAVELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-239-6017",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MS LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "2150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; 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.