Provider Demographics
NPI:1629737473
Name:ENLIGHTENMENT PSYCHIATRY LLC
Entity Type:Organization
Organization Name:ENLIGHTENMENT PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNORTUM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:320-321-9599
Mailing Address - Street 1:3970 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-4415
Mailing Address - Country:US
Mailing Address - Phone:320-226-2361
Mailing Address - Fax:320-321-1205
Practice Address - Street 1:1319 GROVE AVE
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1725
Practice Address - Country:US
Practice Address - Phone:320-321-9599
Practice Address - Fax:320-321-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013555887OtherNPI