Provider Demographics
NPI:1417591793
Name:ENLIGHTEN UP THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:ENLIGHTEN UP THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-274-2946
Mailing Address - Street 1:11133 ACADEMY RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6868
Mailing Address - Country:US
Mailing Address - Phone:505-274-2946
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE J2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3572
Practice Address - Country:US
Practice Address - Phone:505-274-2946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty