Healthcare Provider Details

I. General information

NPI: 1851678445
Provider Name (Legal Business Name): ENJOLI CHELISE EICHELBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 108
LONG BEACH CA
90807-4023
US

IV. Provider business mailing address

8331 E LITTLEFIELD ST 8331 EAST LITTLEFIELD STREET
LONG BEACH CA
90808-3332
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-2006
  • Fax:
Mailing address:
  • Phone: 562-912-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number31491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: