Healthcare Provider Details

I. General information

NPI: 1629984489
Provider Name (Legal Business Name): ENSO COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W CENTRAL AVE
AVIS PA
17721-8901
US

IV. Provider business mailing address

302 W CENTRAL AVE PO BOX 50
AVIS PA
17721-8901
US

V. Phone/Fax

Practice location:
  • Phone: 570-360-9084
  • Fax:
Mailing address:
  • Phone: 570-360-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY CLARKE
Title or Position: OWNER, THERAPIST
Credential: MA, LPC, NCC
Phone: 570-360-9084