Healthcare Provider Details

I. General information

NPI: 1730913625
Provider Name (Legal Business Name): ANDREW ENZOR LPC-ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186A FORESTWOOD DR
NASHVILLE TN
37209-4517
US

IV. Provider business mailing address

186A FORESTWOOD DR
NASHVILLE TN
37209-4517
US

V. Phone/Fax

Practice location:
  • Phone: 469-834-2503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: