Provider Demographics
NPI:1437880283
Name:KINDRED SPIRIT LATINO CENTER FOR GRIEF AND LOSS, LLC
Entity Type:Organization
Organization Name:KINDRED SPIRIT LATINO CENTER FOR GRIEF AND LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENEDINA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW-S
Authorized Official - Phone:956-342-4354
Mailing Address - Street 1:908 E FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2614
Mailing Address - Country:US
Mailing Address - Phone:956-342-4354
Mailing Address - Fax:
Practice Address - Street 1:908 E FERGUSON ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2614
Practice Address - Country:US
Practice Address - Phone:956-342-4354
Practice Address - Fax:956-601-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891704052Medicaid