Illuminate Mental Health PA

Primary specialty

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

Legal business name

ILLUMINATE MENTAL HEALTH PA

Doing business as

Illuminate Mental Health

Practice address

12627 San Jose Blvd Ste 301
Jacksonville, FL 32223-8639

Phone

(540) 222-3495

NPI assigned

Jan 24, 2024

Last updated

Jan 24, 2024By 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

Mr. Matthew MewhorterNPI 1952874596

Title

Vice President/Officer

Phone

(540) 222-3495

Specialties & licenses 1

Addresses

Other names 1

• Illuminate Mental Health Doing business as

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.

• Matthew P Mewhorter

  • Professional Counselor
  • Culpeper, VA
  • NPI 1952874596
  NPD Authorized official

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1720840846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "681 BOX BRANCH CIR",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322594379",
            "telephone_number": "540-222-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12627 SAN JOSE BLVD STE 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238639",
            "telephone_number": "540-222-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE MENTAL HEALTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "MEWHORTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "VICE PRESIDENT/OFFICER",
        "authorized_official_telephone_number": "540-222-3495",
        "authorized_official_name_prefix": "Mr."
    },
    "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": [
        {
            "organization_name": "Illuminate Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Etleva Iliazi
• Laurie Ann Iliff, APRN
• Michael Andrew Illovsky, MD
• Illumia Health LLC
• Illuminate Church of the Sacred Jewels
• Valentine Iloduba, MSPAS PA-C
• Im Sulzbacher Center for the Homeless, Inc (Sulzbacher Village Pediatric Health)
• Im Sulzbacher Center for the Homeless, Inc (Sulzbacher Center)
• Peter O Im, O.D.
• Ima Evaluations

• Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.