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General NPI Number Information
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NPI Number | 1740745470
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Entity Type | Organization
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Legal Business Name | TJAL ENTERPRISES INC.
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 1131E MACK BAYOU RD
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3113
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Country | US
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Telephone | 850-601-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 24 DELBERT LN
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3678
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Country | US
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Telephone | 321-720-8878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN LESTOURGEON
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Credential | LMHC
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Telephone | 321-720-8878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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