| Enlightened Ways Therapy, Llc | |
|
2319 Boulder Ln Beloit WI 53511-6709 | |
| (608) 346-8843 | |
| Not Available |
| Full Name | Enlightened Ways Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2319 Boulder Ln, Beloit, Wisconsin |
| Authorized Official Name and Position | Amberly Mixon (OWNER) |
| Authorized Official Contact | 6083468843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enlightened Ways Therapy, Llc 2319 Boulder Ln Beloit WI 53511-6709 Ph: () - | Enlightened Ways Therapy, Llc 2319 Boulder Ln Beloit WI 53511-6709 Ph: (608) 346-8843 |
| NPI Number | 1073250437 |
|---|---|
| Provider Enumeration Date | 05/17/2022 |
| Last Update Date | 04/13/2023 |
| Certification Date | 04/13/2023 |
| Medicare PECOS PAC ID | 9830560747 |
|---|---|
| Medicare Enrollment ID | O20230131002615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073250437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| Provider Name | Faith E Mattison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487686648 PECOS PAC ID: 1355386368 Enrollment ID: I20050621000576 |
| Provider Name | Amberly Jean Mixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407401771 PECOS PAC ID: 1850762766 Enrollment ID: I20230131002656 |
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