Organization
ILLUMINATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SARAH GRAVELLE THOENY MS LMFT (OWNER)
(612) 239-6017
Entity
Organization
Contact information
Practice address
1660 HIGHWAY 100 S, SUITE 502, ST LOUIS PARK, MN 55416-1529
(612) 239-6017
Mailing address
1660 HIGHWAY 100 S, SUITE 502, ST LOUIS PARK, MN 55416-1529
(612) 239-6017
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2150
MN
Other
Enumeration date
02/19/2014
Last updated
02/19/2014
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