NPIMap

Organization Active NPI

Illuminate My Life Counseling

  • Clinical Social Worker
  • Traverse City, MI
National Provider Identifier
1902570591
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
ILLUMINATE MY LIFE COUNSELING
Doing business as
Illuminate My Life Counseling
Practice address
2692 S M 37
Traverse City, MI 49685-9187
Phone
(231) 570-0627
NPI assigned
Aug 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Jenna Genereaux, LMSWNPI 1205355674
Title
LMSW
Phone
(231) 570-0627

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2692 S M 37
Traverse City, MI 49685-9187

Mailing address

2692 S M 37
Traverse City, MI 49685-9187

Other names 1

  • Illuminate My Life Counseling Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL 12313686270 Direct

National Provider Directory

National Provider Directory

Locations

2692 S M 37
Traverse City, MI 49685
Phone (231) 570-0627

Practitioners & affiliated clinicians

Practitioners 6

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": "1628208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1902570591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2692 S M 37",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496859187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2692 S M 37",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496859187",
            "telephone_number": "231-570-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE MY LIFE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "GENEREAUX",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "LMSW",
        "authorized_official_telephone_number": "231-570-0627",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "12313686270",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fax",
            "address_1": "2692 S M 37",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496859187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Illuminate My Life Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.