Provider Demographics
NPI:1275105223
Name:ENTERPRISE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:ENTERPRISE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S, IMH-E
Authorized Official - Phone:334-447-1717
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2542
Mailing Address - Country:US
Mailing Address - Phone:334-447-1717
Mailing Address - Fax:
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2542
Practice Address - Country:US
Practice Address - Phone:334-447-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093325268OtherNPI
AL1417474776OtherNPI