Provider Demographics
NPI:1508545617
Name:ENRIQUEZ, L. MARIEL (MA)
Entity Type:Individual
Prefix:
First Name:L. MARIEL
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARIEL
Other - Middle Name:
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:10501 E SEVEN GENERATIONS WAY STE 201-05
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5828
Mailing Address - Country:US
Mailing Address - Phone:520-329-5051
Mailing Address - Fax:
Practice Address - Street 1:10501 E SEVEN GENERATIONS WAY STE 201-05
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5828
Practice Address - Country:US
Practice Address - Phone:520-329-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health