Illuminare LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ILLUMINARE LLC

Doing business as

Illuminare

Practice address

601 Greene Dr
Greenville, KY 42345-1451

Phone

(270) 377-7137

Fax

(270) 641-0857

NPI assigned

Sep 10, 2018

Last updated

Sep 9, 2022By 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

Gretchen Davis

Title

Ceo

Phone

(270) 377-7137

Specialties & licenses 2

Addresses

Other names 1

• Illuminare Doing business as

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1992288518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42",
            "city": "POWDERLY",
            "state": "KY",
            "postal_code": "423670042",
            "telephone_number": "270-377-7137",
            "fax_number": "270-641-0857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GREENE DR",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451451",
            "telephone_number": "270-377-7137",
            "fax_number": "270-641-0857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-377-7137"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illuminare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Illuminare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Misti Dawn Herrin, PTA
• Jana Hinkle
• Dina Holland
• Kendal Madison Hooper
• Randy A Hultberg, LCSW
• Mary Jarvis
• Angela Maria Johnson
• Heather R Johnson, PHARMD
• Lacey A Johnson, APRN
• Kellyn Jones, LCSW

• Mental Health Counselor in Greenville, KY
• Providers in Greenville, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.