Provider Demographics
NPI:1528730561
Name:ENLIGHTEN BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:ENLIGHTEN BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXUS
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,RBT
Authorized Official - Phone:229-296-0222
Mailing Address - Street 1:2105 NOTTINGHAM WAY APT P5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2388
Mailing Address - Country:US
Mailing Address - Phone:229-296-0222
Mailing Address - Fax:
Practice Address - Street 1:2105 NOTTINGHAM WAY APT P5
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2388
Practice Address - Country:US
Practice Address - Phone:229-296-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health