Provider Demographics
NPI:1194558981
Name:ENLIGHTENMENT MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:ENLIGHTENMENT MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-545-2674
Mailing Address - Street 1:4 TRIMBLE ST # 2
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1508
Mailing Address - Country:US
Mailing Address - Phone:929-393-3897
Mailing Address - Fax:
Practice Address - Street 1:370 E 160TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4404
Practice Address - Country:US
Practice Address - Phone:917-545-2674
Practice Address - Fax:718-709-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty