Ennis, Jack

Ennis, Jack is an individual health care provider with primary practice located at 2160 N Illinois St , Indianapolis IN 46202-1334. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ennis, Jack can be contacted via phone (317) 937-3700.

Contact Information

Primary practice address
2160 N Illinois St Indianapolis IN 46202-1334
Phone: (317) 937-3700
Fax: (317) 937-3710
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20040742 Indiana

Profile Details

NPI number 1194773028
LBN Legal business name Ennis, Jack
Credentials PSYD, HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Mar 15th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194773028 NPPES
Indiana MEDICAID 200254160

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