| Illume Psychology Incorporated | |
|
245 Kentucky Street Suite A Petaluma CA 94952 | |
| (707) 216-1612 | |
| Not Available |
| Full Name | Illume Psychology Incorporated |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 245 Kentucky Street, Petaluma, California |
| Authorized Official Name and Position | Larissa Laska-ruebusch (PRESIDENT) |
| Authorized Official Contact | 7072161612 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illume Psychology Incorporated 245 Kentucky Street Suite A Petaluma CA 94952 Ph: (707) 216-1612 | Illume Psychology Incorporated 245 Kentucky Street Suite A Petaluma CA 94952 Ph: (707) 216-1612 |
| NPI Number | 1952070252 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 09/09/2021 |
| Certification Date | 09/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952070252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Primary |
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