| Tkt Enlightenment, Llc | |
|
17720 Corporate Woods Dr San Antonio TX 78259-3500 | |
| (210) 495-3627 | |
| (210) 491-3581 |
| Full Name | Tkt Enlightenment, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 17720 Corporate Woods Dr, San Antonio, Texas |
| Authorized Official Name and Position | Henry Lysell Polk (CEO) |
| Authorized Official Contact | 2108578301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tkt Enlightenment, Llc 17503 La Cantera Pkwy Suite 104, #485 San Antonio TX 78257-8207 Ph: (210) 857-8301 | Tkt Enlightenment, Llc 17720 Corporate Woods Dr San Antonio TX 78259-3500 Ph: (210) 495-3627 |
| NPI Number | 1407128218 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 05/25/2012 |
| Medicare PECOS PAC ID | 1355504457 |
|---|---|
| Medicare Enrollment ID | O20120530000593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407128218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | M7529 (Texas) | Primary |
| Provider Name | Henry L Polk |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053390013 PECOS PAC ID: 8325125214 Enrollment ID: I20080402000453 |
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