Provider Demographics
NPI:1871178046
Name:HENRIQUEZ COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:HENRIQUEZ COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANSELY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-902-1091
Mailing Address - Street 1:1221 E HERRING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4325
Mailing Address - Country:US
Mailing Address - Phone:661-902-1091
Mailing Address - Fax:
Practice Address - Street 1:1221 E HERRING AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4325
Practice Address - Country:US
Practice Address - Phone:661-902-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty