MEDICARE: ENLIVEN THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1013630284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIVEN THERAPY LLC

Provider Business Mailing Address
First Line	:	701 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2520
Country	:	US
Telephone Number	:	251-286-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2520
Country	:	US
Telephone Number	:	251-286-0707
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	WHITNEY JERKINS
Credential	:	LPC
Telephone Number	:	251-238-5402

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	12/11/2023

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Directions to “ENLIVEN THERAPY LLC ” Practice Location

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