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General NPI Number Information
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NPI Number | 1699405241
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Entity Type | Organization
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Legal Business Name | ENALEN FAMILY COUNSELING A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 41593 WINCHESTER RD STE 200
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City | TEMECULA
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State | CA
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Zip | 92590-4857
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Country | US
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Telephone | 951-704-6554
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Fax | 800-577-8435
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Provider Business Mailing Address
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Address Line | 27475 YNEZ RD # 146
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City | TEMECULA
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State | CA
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Zip | 92591-4612
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Country | US
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Telephone | 951-704-6554
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Fax | 800-577-8535
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | TRACY ENALEN
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Credential | LMFT
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Telephone | 951-704-6554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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