| Illuminate Supervision And Consulting | |
|
400 5th St Lake View IA 51450-7725 | |
| (515) 639-0676 | |
| (515) 639-0676 |
| Full Name | Illuminate Supervision And Consulting |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 400 5th St, Lake View, Iowa |
| Authorized Official Name and Position | Alecia Ann Smith (OWNER) |
| Authorized Official Contact | 5156390676 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate Supervision And Consulting Po Box 136 Lake View IA 51450-0136 Ph: (515) 639-0676 | Illuminate Supervision And Consulting 400 5th St Lake View IA 51450-7725 Ph: (515) 639-0676 |
| NPI Number | 1194695221 |
|---|---|
| Provider Enumeration Date | 11/05/2025 |
| Last Update Date | 11/05/2025 |
| Certification Date | 11/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194695221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Theodore R. Liautaud Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 421 E Shore Dr, Lake View, IA 51450 Phone: 712-657-2211 Fax: 712-657-2106 |