# ILLUMINARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Illuminare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992288518
- **Authorized official:** GRETCHEN DAVIS (CEO)
- **Authorized official phone:** (270) 377-7137

## Contact information

- **Practice address:** 601 GREENE DR, GREENVILLE, KY 42345-1451
- **Practice address phone:** (270) 377-7137
- **Practice address fax:** (270) 641-0857
- **Mailing address:** PO BOX 42, POWDERLY, KY 42367-0042
- **Mailing address phone:** (270) 377-7137
- **Mailing address fax:** (270) 641-0857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |

## Other

- **Enumeration date:** 09/10/2018
- **Last updated:** 09/09/2022