| Illume Wellness Group | |
|
1904 E Chicago Rd Sturgis MI 49091-8522 | |
| (269) 503-1804 | |
| Not Available |
| Full Name | Illume Wellness Group |
|---|---|
| Speciality | Counselor |
| Location | 1904 E Chicago Rd, Sturgis, Michigan |
| Authorized Official Name and Position | Nicole R Merchant (OWNER/PARTNER) |
| Authorized Official Contact | 2695031804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illume Wellness Group 971 S Centerville Rd # 145 Sturgis MI 49091-2502 Ph: (269) 503-1804 | Illume Wellness Group 1904 E Chicago Rd Sturgis MI 49091-8522 Ph: (269) 503-1804 |
| NPI Number | 1942978572 |
|---|---|
| Provider Enumeration Date | 08/30/2021 |
| Last Update Date | 09/26/2021 |
| Certification Date | 09/26/2021 |
| Medicare PECOS PAC ID | 4880088210 |
|---|---|
| Medicare Enrollment ID | O20220301002605 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942978572 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Celeste Salvador-gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699210963 PECOS PAC ID: 4587067756 Enrollment ID: I20210726001996 |
| Provider Name | Nicole R F Merchant |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184727570 PECOS PAC ID: 7416341847 Enrollment ID: I20231117001941 |
| Provider Name | Travis Jason Crotser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811535164 PECOS PAC ID: 9234523663 Enrollment ID: I20231129000666 |
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