Healthcare Provider Details

I. General information

NPI: 1417591793
Provider Name (Legal Business Name): ENLIGHTEN UP THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 BARSTOW ST NE STE B
ALBUQUERQUE NM
87111-1056
US

IV. Provider business mailing address

11133 ACADEMY RIDGE RD NE
ALBUQUERQUE NM
87111-6868
US

V. Phone/Fax

Practice location:
  • Phone: 505-274-2946
  • Fax:
Mailing address:
  • Phone: 505-274-2946
  • 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: JENNIFER MCGOUGH
Title or Position: OWNER
Credential:
Phone: 505-274-2946