Illumination Psychotherapy, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ILLUMINATION PSYCHOTHERAPY, PLLC

Practice address

450 S Maple Rd Ste 858
Ann Arbor, MI 48103-3835

Phone

(773) 318-7304

NPI assigned

Jan 31, 2024

Organization subpart

No

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

Authorized official

Name

Garrett ShotwellNPI 1275074262

Title

Owner

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.

• Garrett Shotwell, LMSW

  • Social Worker
  • Ann Arbor, MI
  • NPI 1275074262
  NPD Authorized official

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1245093590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 ABBOTT AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481034107",
            "telephone_number": "773-318-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S MAPLE RD STE 858",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033835",
            "telephone_number": "773-318-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATION PSYCHOTHERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "SHOTWELL",
        "authorized_official_first_name": "GARRETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-318-7304"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne-Marie M Ilgen, MSW
• Mark Andrew Ilgen, PHD
• Israel Illingworth, MA, LPC
• Kelley Lynn Illis, RN
• Kristi Illis, RN
• David Soon Im, MD
• Masami Imai, CNIM
• Sabrina Imam, MD
• Elizabeth A Imbesi, PHD, LLP
• Folasade Oseinene Imeokparia, M.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.