Organization
TKT ENLIGHTENMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LYSELL POLK M.D. (CEO)
(210) 857-8301
Entity
Organization
Contact information
Practice address
17720 CORPORATE WOODS DR, SAN ANTONIO, TX 78259-3500
(210) 495-3627
(210) 491-3581
Mailing address
17503 LA CANTERA PKWY, SUITE 104, #485, SAN ANTONIO, TX 78257-8207
(210) 857-8301
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
M7529
TX
Other
Enumeration date
02/09/2012
Last updated
05/25/2012
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