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General NPI Number Information
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NPI Number | 1689225963
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Entity Type | Organization
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Legal Business Name | ENLIGHTENING MINDS, LLC
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 600 CENTRAL AVE STE 408
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City | GREAT FALLS
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State | MT
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Zip | 59401-3141
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Country | US
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Telephone | 406-315-2227
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Fax | 406-315-2227
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Provider Business Mailing Address
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Address Line | 600 CENTRAL AVE STE 408
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City | GREAT FALLS
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State | MT
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Zip | 59401-3141
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Country | US
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Telephone | 406-315-2227
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Fax | 406-315-2227
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA DAVENPORT
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Credential | LAC, LCPC
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Telephone | 406-315-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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