MEDICARE: JOEL ENOS

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	106S00000X	Behavior Technician		CO

General Provider Information

NPI Number	:	1962105551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL ENOS

Provider Business Mailing Address
First Line	:	2120 E LA SALLE ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80909-2218
Country	:	US
Telephone Number	:	719-466-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E LA SALLE ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80909-2218
Country	:	US
Telephone Number	:	719-466-4809
Fax Number	:

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

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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Directions to “ JOEL ENOS ” Practice Location

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