Provider Demographics
NPI:1013630284
Name:ENLIVEN THERAPY LLC
Entity Type:Organization
Organization Name:ENLIVEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:251-238-5402
Mailing Address - Street 1:701 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-2520
Mailing Address - Country:US
Mailing Address - Phone:251-286-0707
Mailing Address - Fax:
Practice Address - Street 1:701 FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-2520
Practice Address - Country:US
Practice Address - Phone:251-286-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty