Provider Demographics
NPI:1144789496
Name:ENLIGHTENMENT & WELLNESS LLC
Entity Type:Organization
Organization Name:ENLIGHTENMENT & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAC
Authorized Official - Phone:765-727-0990
Mailing Address - Street 1:6062 COUNTRYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1262
Mailing Address - Country:US
Mailing Address - Phone:765-727-0990
Mailing Address - Fax:
Practice Address - Street 1:910 N SHADELAND AVE STE 11
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4810
Practice Address - Country:US
Practice Address - Phone:317-441-7625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)