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Organization
ILLUMINATE MINDS
Active
Organization
ILLUMINATE MINDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE AGAZARYAN (CFO)
(818) 624-8919
Entity
Organization
Contact information
Practice address
10913 WHIPPLE ST UNIT 103, NORTH HOLLYWOOD, CA 91602-4307
(818) 624-8919
Mailing address
10913 WHIPPLE ST UNIT 103, NORTH HOLLYWOOD, CA 91602-4307
(818) 624-8919
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
09/05/2022
Last updated
09/05/2022
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