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General NPI Number Information
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NPI Number | 1992494371
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Entity Type | Organization
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Legal Business Name | ENLIGHTENED MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 401 S EARL AVE STE 4A
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City | LAFAYETTE
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State | IN
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Zip | 47904-3265
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Country | US
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Telephone | 317-597-6501
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 BLACKBIRD CT
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-6501
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Country | US
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Telephone | 765-490-2090
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL PSYCHOLOGIST
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Name | TAMMY LESHER
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Credential | PSY.D., HSPP
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Telephone | 765-490-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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