Jack Ennis is a Clinical in Terre Haute, Indiana. Jack Ennis practices all healthcare services and medical treatments related to Clinical. The NPI Number for Jack Ennis is 1194773028. The last update date is 2011-03-15.
Jack Ennis's current location address is Po Box 4323, Terre Haute, Indiana. You can contact this provider via phone number 8122318323 and fax number 8122318400. The mailing address for Jack Ennis is Po Box 4323, Terre Haute, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack Ennis |
|---|---|
| Address | Po Box 4323, Terre Haute, Indiana |
| Phone Number | 8122318323 |
| Fax Number | 8122318400 |
| Sole Proprietor | N |
| Credentials | PSYD, HSPP |
NPI Number Detail
| NPI Number | 1194773028 |
|---|---|
| Provider Enumeration Date | 2006-05-04 |
| Last Updated Date | 2011-03-15 |
Provider Mailing Address Detail
| Address | Po Box 4323 |
|---|---|
| City | Terre Haute |
| State | Indiana (IN) |
| Post Code | 478040323 |
| Phone Number | 8122318323 |
| Fax Number | 8122318400 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 20040742 |
|
Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200254160 | IN | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Jack Ennis by the Centers for Medicare & Medicaid Services?
The Jack Ennis has been assigned the NPI (National Provider Identifier) 1194773028. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Where is the Jack Ennis located?
The Jack Ennis is located at Po Box 4323, Terre Haute, IN 478040323.
What is Jack Ennis's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Jack Ennis is Clinical, and the taxonomy code that categorizes this field of expertise is 103Tc0700X.
When was the Jack Ennis's 1194773028 issued?
The Jack Ennis's 1194773028 was issued on 2006-05-04.
As of what date were the Jack Ennis's details last updated?
The information pertaining to the Jack Ennis, including its address, specialty, and other details, was most recently updated on 2011-03-15.