Healthcare Provider Details

I. General information

NPI: 1316954530
Provider Name (Legal Business Name): DOUGLAS RONALD ENSOR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 OAK VALLEY DR SUITE 100
ANN ARBOR MI
48103-8943
US

IV. Provider business mailing address

2395 OAK VALLEY DR SUITE 100
ANN ARBOR MI
48103-8943
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-5181
  • Fax: 734-995-9011
Mailing address:
  • Phone: 734-995-5181
  • Fax: 734-995-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301002983
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: