Provider Demographics
NPI:1861040602
Name:ENGULU, FURAHA CHRISTINE
Entity Type:Individual
Prefix:
First Name:FURAHA
Middle Name:CHRISTINE
Last Name:ENGULU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 SPRING SONG DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2739
Mailing Address - Country:US
Mailing Address - Phone:817-914-5869
Mailing Address - Fax:
Practice Address - Street 1:1098 PROVENCE PL
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2769
Practice Address - Country:US
Practice Address - Phone:817-914-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-96926106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
19-96926OtherREGISTERED BEHAVIOR TECHNICIAN