Organization
ILLUMINATE MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDRA M BUTEYN LPC (OWNER)
(920) 215-2260
Entity
Organization
Contact information
Practice address
626 E LONGVIEW DR LOWR LEVEL, APPLETON, WI 54911-2130
(920) 215-2260
Mailing address
626 E LONGVIEW DR LOWR LEVEL, APPLETON, WI 54911-2130
(920) 215-2260
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/30/2024
Last updated
10/30/2024
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