Healthcare Provider Details

I. General information

NPI: 1487537189
Provider Name (Legal Business Name): ENLIGHTENED PATH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 N 1120 W
PROVO UT
84604-1180
US

IV. Provider business mailing address

1463 S 3750 E
SPANISH FORK UT
84660-6387
US

V. Phone/Fax

Practice location:
  • Phone: 385-233-0672
  • Fax:
Mailing address:
  • Phone: 385-225-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLIE JOHNSON
Title or Position: OWNER
Credential: LCSW
Phone: 385-233-0672