Provider Demographics
NPI:1235017872
Name:ILLUMINAURA EMDR & PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:ILLUMINAURA EMDR & PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCH NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:360-369-0864
Mailing Address - Street 1:1709 HOMANN DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2841
Mailing Address - Country:US
Mailing Address - Phone:253-365-7153
Mailing Address - Fax:
Practice Address - Street 1:1709 HOMANN DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2841
Practice Address - Country:US
Practice Address - Phone:253-365-7153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty