Individual
EMA BASIE ENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TCADC
Contact information
Practice address
201 E 11TH ST, SPENCER, IA 51301-4460
(800) 242-5101
Mailing address
5073 370TH ST, CYLINDER, IA 50528-8017
(712) 298-4284
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T20047
IA
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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