| Doctor Name: | MR. GLEN ALAN ENSINGER |
| NPI Number: | 1205144466 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSED |
| License Number: | 180.004733 |
| Business Practice Address: | 24 Country Club Lane Pinedale, WY - 829410856 |
| Business Phone Number: | 3073672111 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 856, 24 Country Club Lane PINEDALE |
| State: | WY |
| Postal Code: | 82941 |
| Phone Number: | 3073672111 |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2010 |
| NPI Last Update Date: | 09/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.004733 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |