Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 69421 | TX |
N | 101YP1600X | Pastoral Counselor | 69421 | TX |
Y | 101YP2500X | Professional Counselor | 69421 | TX |
NPI | 1083962146 |
---|---|
Provider Name | Mrs. Enjole Dionne Delgado |
First Address | Mansfield, TX 76063-3201 |
Second Address | Mansfield, TX 76063-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083962146 | FOCUS FOR LIVING (01) | TX |