Provider Demographics
NPI:1760726715
Name:ENZINNA, JEFFREY CHARLES (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:ENZINNA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 FM 359 RD # 238
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1296
Mailing Address - Country:US
Mailing Address - Phone:281-818-6408
Mailing Address - Fax:
Practice Address - Street 1:1860 FM 359 RD # 238
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-1296
Practice Address - Country:US
Practice Address - Phone:281-818-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11-068-16103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst