Individual
KAY E. ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1034
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM600035
VALUE OPTIONS
NM
Enumeration date
10/02/2006
Last updated
03/07/2011
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