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General NPI Number Information
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NPI Number | 1144789496
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Entity Type | Organization
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Legal Business Name | ENLIGHTENMENT & WELLNESS LLC
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Dates
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Enumeration Date | 03/17/2019
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Last Update Date | 03/17/2019
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Provider Practice Location Address
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Address Line | 910 N SHADELAND AVE STE 11
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4810
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Country | US
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Telephone | 317-441-7625
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Fax |
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Provider Business Mailing Address
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Address Line | 6062 COUNTRYBROOK RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-1262
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Country | US
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Telephone | 765-727-0990
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. BARBARA J HUMPHREY
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Credential | MA, LCAC
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Telephone | 765-727-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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