Healthcare Provider Details

I. General information

NPI: 1164353470
Provider Name (Legal Business Name): ENLUMEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 125TH ST
FAIRFIELD IA
52556-8962
US

IV. Provider business mailing address

2154 125TH STREET
FAIRFIELD IA
52556
US

V. Phone/Fax

Practice location:
  • Phone: 641-919-2474
  • Fax:
Mailing address:
  • Phone: 641-919-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN EARL PRETTYMAN
Title or Position: CO-OWNER
Credential: LISW
Phone: 641-919-2474