Provider Demographics
NPI:1699405241
Name:ENALEN FAMILY COUNSELING A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ENALEN FAMILY COUNSELING A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENALEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-704-6554
Mailing Address - Street 1:27475 YNEZ RD # 146
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4612
Mailing Address - Country:US
Mailing Address - Phone:951-704-6554
Mailing Address - Fax:800-577-8535
Practice Address - Street 1:41593 WINCHESTER RD STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4857
Practice Address - Country:US
Practice Address - Phone:951-704-6554
Practice Address - Fax:800-577-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty