| Enlightened Path Pllc | |
|
1881 N 1120 W Provo UT 84604-1180 | |
| (385) 233-0672 | |
| Not Available |
| Full Name | Enlightened Path Pllc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1881 N 1120 W, Provo, Utah |
| Authorized Official Name and Position | Kimberlie Johnson (OWNER) |
| Authorized Official Contact | 3852330672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enlightened Path Pllc 1463 S 3750 E Spanish Fork UT 84660-6387 Ph: (385) 225-5810 | Enlightened Path Pllc 1881 N 1120 W Provo UT 84604-1180 Ph: (385) 233-0672 |
| NPI Number | 1487537189 |
|---|---|
| Provider Enumeration Date | 07/29/2025 |
| Last Update Date | 07/29/2025 |
| Certification Date | 07/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487537189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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