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General NPI Number Information
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NPI Number | 1316432925
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Entity Type | Individual
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Provider Name | ENRIQUE CORREA JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 2400 TRAWOOD DR STE 301A
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City | EL PASO
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State | TX
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Zip | 79936-4122
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Country | US
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Telephone | 915-443-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 RUSTIC BEND PL
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City | EL PASO
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State | TX
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Zip | 79928-5275
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Country | US
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Telephone | 915-422-2411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 72099
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License Number State | TX
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