Provider Demographics
NPI:1548979347
Name:ENLIVEN PSYCHIATRIC ASSOCIATES LLC
Entity type:Organization
Organization Name:ENLIVEN PSYCHIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOLBREKKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELVAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-922-2618
Mailing Address - Street 1:2801 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4134
Mailing Address - Country:US
Mailing Address - Phone:321-209-8786
Mailing Address - Fax:
Practice Address - Street 1:2801 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4134
Practice Address - Country:US
Practice Address - Phone:321-209-8786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty