NPIMap

Organization Active NPI

Ilera Therapy LLC

  • Professional Counselor
  • Roswell, GA
National Provider Identifier
1275280604
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
ILERA THERAPY LLC
Practice address
300 Colonial Center Pkwy Ste 100N
Roswell, GA 30076-4892
Phone
(678) 664-8298
NPI assigned
Mar 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Ashley BonvillainNPI 1063753002
Title
Ceo
Phone
(678) 664-8298

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
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

300 Colonial Center Pkwy Ste 100N
Roswell, GA 30076-4892

Mailing address

100 Commerce Dr Unit 191
Tyrone, GA 30290-8009

National Provider Directory

National Provider Directory

Locations

100 Commerce Dr
Unit 191
Tyrone, GA 30290

Practitioners & affiliated clinicians

Practitioners 1

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": "1646524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1275280604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COMMERCE DR UNIT 191",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302908009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLONIAL CENTER PKWY STE 100N",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764892",
            "telephone_number": "678-664-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILERA THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-06",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "BONVILLAIN",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-664-8298"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.