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Organization
ILLUME PSYCHOLOGY INCORPORATED
Active
Organization
ILLUME PSYCHOLOGY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA LASKA-RUEBUSCH PSY.D (PRESIDENT)
(707) 216-1612
Entity
Organization
Contact information
Practice address
245 KENTUCKY STREET, SUITE A, PETALUMA, CA 94952
(707) 216-1612
Mailing address
245 KENTUCKY STREET, SUITE A, PETALUMA, CA 94952
(707) 216-1612
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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