Illume Counseling & Play Therapy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ILLUME COUNSELING & PLAY THERAPY

Practice address

35008 Emerald Coast Pkwy Ste 203
Destin, FL 32541-4752

Phone

(251) 209-0680

NPI assigned

Sep 22, 2020

Last updated

Dec 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelsey Laine Backes

Title

President

Phone

(251) 209-0216

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelsey Laine Schneider, LMHC, M.ED, NCC

  • Mental Health Counselor
  • Destin, FL
  • NPI 1902346679
  NPD

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1508472648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 PRIMROSE CIR",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412232",
            "telephone_number": "251-209-0680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35008 EMERALD COAST PKWY STE 203",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325414752",
            "telephone_number": "251-209-0680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUME COUNSELING & PLAY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "BACKES",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_middle_name": "LAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-209-0216",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Humbarger
• Tami Elizabeth Huston, OT
• Kara Madonna Hyman, APRN
• Joshua Hynes
• Rosa V. Iglesias, RD
• In Your Dreams International Inc (Emerald Coast Sleep Disorder Center)
• Integrated Regional Laboratories Pathology Services, LLC
• Iperformance Center
• J. Luke Lentz, MD, PA (Lentz Lyme Clinic)
• James A Jackson, PHARMD

• Mental Health Counselor in Destin, FL
• Providers in Destin, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.