Illumination, LLC
NPI #1194140749 in St Louis Park, Minnesota
Provider Information
- NPI Number
- 1194140749
- Entity Type
- Organization
- Organization Name
- Illumination, LLC
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Feb 19, 2014
- Last Updated
- Feb 19, 2014
Practice Location
- Address
- 1660 HIGHWAY 100 S
- Address 2
- SUITE 502
- City
- St Louis Park
- State
- Minnesota
- ZIP Code
- 55416-1529
- Phone
- (612) 239-6017
Authorized Official
- Name
- MISS SARAH GRAVELLE THOENY, MS LMFT
- Title
- OWNER
- Phone
- (612) 239-6017
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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