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General NPI Number Information
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NPI Number | 1760726715
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Entity Type | Individual
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Provider Name | JEFFREY CHARLES ENZINNA BCBA
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Gender | Male
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1860 FM 359 RD # 238
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City | RICHMOND
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State | TX
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Zip | 77406-1296
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Country | US
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Telephone | 281-818-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 FM 359 RD # 238
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City | RICHMOND
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State | TX
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Zip | 77406-1296
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Country | US
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Telephone | 281-818-6408
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11-068-16
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License Number State |
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