Provider Demographics
NPI:1194813386
Name:ILUMIN, BEATRICE HOLTZ (PHD LPCC)
Entity type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:HOLTZ
Last Name:ILUMIN
Suffix:
Gender:F
Credentials:PHD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W ZIA RD APT 102C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6944
Mailing Address - Country:US
Mailing Address - Phone:505-690-3881
Mailing Address - Fax:
Practice Address - Street 1:501 W ZIA RD APT 102C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6944
Practice Address - Country:US
Practice Address - Phone:505-690-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39476101Y00000X
NM0111471101YM0800X
NM0179041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58522255Medicaid