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Individual

DR. DONALD L ENNIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH D

Contact information

Practice address
514 FAIRWAY LAKES DR, GARLAND, TX 75044-5043
(469) 450-5539
Mailing address
PO BOX 496763, GARLAND, TX 75049-6763
(469) 450-5539

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3127
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00F89C
BLUE CROSS
TX
Enumeration date
03/18/2007
Last updated
12/07/2007
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