Provider Demographics
NPI:1780391904
Name:KENJURA, PATRICIA (MED, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KENJURA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1556
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:TX
Mailing Address - Zip Code:78358-0001
Mailing Address - Country:US
Mailing Address - Phone:361-790-6296
Mailing Address - Fax:
Practice Address - Street 1:408 N. FOURTH ST.
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:TX
Practice Address - Zip Code:78358-0001
Practice Address - Country:US
Practice Address - Phone:281-744-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional