Healthcare Provider Details

I. General information

NPI: 1114631207
Provider Name (Legal Business Name): RACHEL ENSIGN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 EASTMAN AVE
MIDLAND MI
48640-6793
US

IV. Provider business mailing address

5697 LESSANDRO ST
SAGINAW MI
48603-3630
US

V. Phone/Fax

Practice location:
  • Phone: 989-372-0601
  • Fax: 989-486-9413
Mailing address:
  • Phone: 989-529-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224632
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: