Healthcare Provider Details

I. General information

NPI: 1821269283
Provider Name (Legal Business Name): WILLIAM DIRELLE ENSLEN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 HEALTHPARK CIR
FORT MYERS FL
33908-3600
US

IV. Provider business mailing address

9470 HEALTHPARK CIR
FORT MYERS FL
33908-3600
US

V. Phone/Fax

Practice location:
  • Phone: 239-985-7791
  • Fax: 239-482-3380
Mailing address:
  • Phone: 239-985-7791
  • Fax: 239-482-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH 0003497
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 0003497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: