NPIMap

Organization Active NPI

Enlightened Ways Therapy, LLC

  • Professional Counselor
  • Beloit, WI
National Provider Identifier
1073250437
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
ENLIGHTENED WAYS THERAPY, LLC
Practice address
2319 Boulder LN
Beloit, WI 53511-6709
Phone
(608) 346-8843
NPI assigned
May 17, 2022
Last updated
Apr 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amberly MixonNPI 1407401771
Title
Owner
Phone
(608) 346-8843

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X

Addresses

Primary practice location

2319 Boulder LN
Beloit, WI 53511-6709

Mailing address

2319 Boulder LN
Beloit, WI 53511-6709

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230131002615 WI Part B Supplier - Clinic/Group Practice 9830560747 Receives reassigned benefits from 9 practitioners
Practice locations: Beloit, WI
O20250205003313 IL Part B Supplier - Clinic/Group Practice 9830560747 Receives reassigned benefits from 2 practitioners
Practice locations: Rockford, IL; Roscoe, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1073250437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 BOULDER LN",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2319 BOULDER LN",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116709",
            "telephone_number": "608-346-8843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIGHTENED WAYS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-17",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A",
        "authorized_official_last_name": "MIXON",
        "authorized_official_first_name": "AMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-346-8843"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.