Provider Demographics
NPI:1669021259
Name:ENLIGHTENED COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ENLIGHTENED COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SISTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RYT
Authorized Official - Phone:734-330-3004
Mailing Address - Street 1:1424 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1998
Mailing Address - Country:US
Mailing Address - Phone:734-330-3004
Mailing Address - Fax:
Practice Address - Street 1:607 10TH ST STE 303
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5829
Practice Address - Country:US
Practice Address - Phone:734-330-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health