Provider Demographics
NPI:1871615203
Name:ENQUIST, KEVIN MICHEAL
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHEAL
Last Name:ENQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N CHURCH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6300
Mailing Address - Country:US
Mailing Address - Phone:559-636-1775
Mailing Address - Fax:559-636-1792
Practice Address - Street 1:113 N CHURCH ST STE 319
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6300
Practice Address - Country:US
Practice Address - Phone:559-636-1775
Practice Address - Fax:559-636-1792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker