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General NPI Number Information
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NPI Number | 1083150379
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Entity Type | Organization
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Legal Business Name | ENLIGHTENED PATH
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 5544 MYRON CIR
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City | LAS VEGAS
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State | NV
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Zip | 89142-1123
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Country | US
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Telephone | 505-814-9745
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Fax |
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Provider Business Mailing Address
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Address Line | 5544 MYRON CIR
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City | LAS VEGAS
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State | NV
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Zip | 89142-1123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO/CEO
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Name | MR. YAUNCAY J LUCAS
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Credential |
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Telephone | 505-814-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2002981062101
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License Number State | NV
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