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Organization
ILLUME COUNSELING & PLAY THERAPY
Active
Organization
ILLUME COUNSELING & PLAY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELSEY LAINE BACKES (PRESIDENT)
(251) 209-0216
Entity
Organization
Contact information
Practice address
35008 EMERALD COAST PKWY STE 203, DESTIN, FL 32541-4752
(251) 209-0680
Mailing address
416 PRIMROSE CIR, DESTIN, FL 32541-2232
(251) 209-0680
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/22/2020
Last updated
12/07/2020
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