Provider Demographics
NPI:1609008838
Name:ENLIGHTENED BEHAVIORAL HEALTH SYSTEMS, L.L.C.
Entity Type:Organization
Organization Name:ENLIGHTENED BEHAVIORAL HEALTH SYSTEMS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-692-3030
Mailing Address - Street 1:4807 WEST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2709
Mailing Address - Country:US
Mailing Address - Phone:210-692-3030
Mailing Address - Fax:210-692-3232
Practice Address - Street 1:4807 WEST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2709
Practice Address - Country:US
Practice Address - Phone:210-692-3030
Practice Address - Fax:210-692-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTPI 282960802251B00000X
TX454916251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB108659OtherMEDICARE OUTPATIENT PTAN
TX282960802Medicaid
454916OtherMEDICARE CMHC CCN
454916OtherMEDICARE CMHC CCN