Provider Information for 1780391904
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PATRICIA KENJURA MEd, LPC
Sex: Female
NPI: 1780391904
Last Updated: 2022-10-28
Certification Date: 2022-10-10
Certification Date: 2022-10-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780391904 | ||||||||
| Enumeration Date | 2022-10-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1556 FULTON, TX 78358-0001 United States Phone: 361-790-6296 | Fax: | ||||||||
| Primary Practice Address | 408 N. FOURTH ST. FULTON, TX 78358-0001 United States Phone: 281-744-3459 | Fax: | ||||||||
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