Healthcare Provider Details

I. General information

NPI: 1659629210
Provider Name (Legal Business Name): RODNEY ENSLEY JR. LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

9412 COTTONWOOD DR
MUNSTER IN
46321-3604
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-3500
  • Fax:
Mailing address:
  • Phone: 219-381-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003125A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: