Provider Demographics
NPI:1306279559
Name:ENOS, CLARENCE AARON (LCMSW)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:AARON
Last Name:ENOS
Suffix:
Gender:M
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3809
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-3809
Mailing Address - Country:US
Mailing Address - Phone:505-863-3377
Mailing Address - Fax:
Practice Address - Street 1:216 W MALONEY AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5214
Practice Address - Country:US
Practice Address - Phone:505-870-1483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07770104100000X
NMX-104301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker