| Illuminate Psychotherapy Pllc | |
|
101 Jordan Dr Chattanooga TN 37421-6732 | |
| (423) 510-1999 | |
| Not Available |
| Full Name | Illuminate Psychotherapy Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 101 Jordan Dr, Chattanooga, Tennessee |
| Authorized Official Name and Position | Judy Gilliam (ADMINISTRATIVE EXPERT) |
| Authorized Official Contact | 4235101999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate Psychotherapy Pllc 101 Jordan Dr Chattanooga TN 37421-6732 Ph: (423) 510-1999 | Illuminate Psychotherapy Pllc 101 Jordan Dr Chattanooga TN 37421-6732 Ph: (423) 510-1999 |
| NPI Number | 1417568890 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Medicare PECOS PAC ID | 1658798988 |
|---|---|
| Medicare Enrollment ID | O20200901000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417568890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Pooja Khariwal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063846822 PECOS PAC ID: 4082031414 Enrollment ID: I20200901000442 |
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