| Enlightened Mind Llc | |
|
2837 Walnut St Port Huron MI 48060-2162 | |
| (810) 689-4547 | |
| Not Available |
| Full Name | Enlightened Mind Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2837 Walnut St, Port Huron, Michigan |
| Authorized Official Name and Position | Nathanael William Russell (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8106894547 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enlightened Mind Llc 2837 Walnut St Port Huron MI 48060-2162 Ph: (810) 858-1759 | Enlightened Mind Llc 2837 Walnut St Port Huron MI 48060-2162 Ph: (810) 689-4547 |
| NPI Number | 1912606997 |
|---|---|
| Provider Enumeration Date | 02/28/2023 |
| Last Update Date | 02/28/2023 |
| Certification Date | 02/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912606997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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