Provider Demographics
NPI:1063802908
Name:ENLIGHTENED SOULS, PLLC
Entity type:Organization
Organization Name:ENLIGHTENED SOULS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, M A, LPC
Authorized Official - Phone:713-539-5727
Mailing Address - Street 1:15818 WHITEGLADE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6800
Mailing Address - Country:US
Mailing Address - Phone:713-539-5727
Mailing Address - Fax:
Practice Address - Street 1:501 MURPHY RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5417
Practice Address - Country:US
Practice Address - Phone:713-539-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX68068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty