Healthcare Provider Details

I. General information

NPI: 1144618083
Provider Name (Legal Business Name): DR. JOCELYN ENABULELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN ENABULELE EDD

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19105 WAXEN ROAD
BOTHELL WA
98012
US

IV. Provider business mailing address

PO BOX 3810
EVERETT WA
98213-8810
US

V. Phone/Fax

Practice location:
  • Phone: 281-630-1032
  • Fax:
Mailing address:
  • Phone: 281-630-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60524424
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: