Provider Demographics
NPI:1700599230
Name:ENLIGHTEN COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:ENLIGHTEN COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESTREE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRC
Authorized Official - Phone:971-915-9344
Mailing Address - Street 1:980 ORCHARDVIEW AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1962
Mailing Address - Country:US
Mailing Address - Phone:971-915-9344
Mailing Address - Fax:503-966-0983
Practice Address - Street 1:2659 COMMERCIAL ST SE STE 216
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4496
Practice Address - Country:US
Practice Address - Phone:971-915-9344
Practice Address - Fax:503-966-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1851878797Medicaid