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Organization
ILLUMINATE MENTAL HEALTH PA
Active
Organization
ILLUMINATE MENTAL HEALTH PA
Active
Other names
Illuminate Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW MEWHORTER (VICE PRESIDENT/OFFICER)
(540) 222-3495
Entity
Organization
Contact information
Practice address
12627 SAN JOSE BLVD STE 301, JACKSONVILLE, FL 32223-8639
(540) 222-3495
Mailing address
681 BOX BRANCH CIR, ST JOHNS, FL 32259-4379
(540) 222-3495
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/24/2024
Last updated
01/24/2024
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