Doctor Name: | MRS. BETTY KAY ENNIS |
NPI Number: | 1194020958 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PLPC |
License Number: | 2010040311 |
Business Practice Address: | 8589 N Farm Road 157 Pleasant Hope, MO - 657259143 |
Business Phone Number: | 4177630979 |
Business Fax Number: | |
Mailing Address: | 8589 N Farm Road 157, PLEASANT HOPE |
State: | MO |
Postal Code: | 657259143 |
Phone Number: | 4177630979 |
Fax Number: | |
NPI Enumeration Date: | 01/25/2011 |
NPI Last Update Date: | 01/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2010040311 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |