MEDICARE: ENJOLI J VARNADO LPC-IT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2135-226	WI
2	101YM0800X	Mental Health Counselor	2135226	WI

General Provider Information

NPI Number	:	1679178040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENJOLI J VARNADO LPC-IT

Provider Business Mailing Address
First Line	:	10026 W TERRA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2908
Country	:	US
Telephone Number	:	262-365-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	10026 W TERRA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2908
Country	:	US
Telephone Number	:	262-365-9601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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