Provider Demographics
NPI:1750088522
Name:ENLIGHTENED COUNSELING & WELLNESS PLLC
Entity type:Organization
Organization Name:ENLIGHTENED COUNSELING & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-760-6651
Mailing Address - Street 1:23730 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8692
Mailing Address - Country:US
Mailing Address - Phone:269-760-6651
Mailing Address - Fax:
Practice Address - Street 1:7912 S 8TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8955
Practice Address - Country:US
Practice Address - Phone:269-760-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013467083OtherPERSONAL NPI