Provider Demographics
NPI:1699348516
Name:ENLIGHTEN BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:ENLIGHTEN BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-300-2846
Mailing Address - Street 1:10810 BOYETTE RD # 3341
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8000
Mailing Address - Country:US
Mailing Address - Phone:813-300-2846
Mailing Address - Fax:
Practice Address - Street 1:10810 BOYETTE RD # 3341
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8000
Practice Address - Country:US
Practice Address - Phone:813-300-2846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder