Provider Demographics
NPI:1114578077
Name:ENCISO MENESES, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ENCISO MENESES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W HARRISON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4403
Mailing Address - Country:US
Mailing Address - Phone:253-856-9000
Mailing Address - Fax:
Practice Address - Street 1:515 W HARRISON ST STE 109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4403
Practice Address - Country:US
Practice Address - Phone:253-520-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor