Healthcare Provider Details

I. General information

NPI: 1225879919
Provider Name (Legal Business Name): HOLLIE ENNISS-POE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 N 2860 E STE 201
ST GEORGE UT
84790-8909
US

IV. Provider business mailing address

249 E TABERNACLE ST
ST GEORGE UT
84770-2978
US

V. Phone/Fax

Practice location:
  • Phone: 435-227-5506
  • Fax:
Mailing address:
  • Phone: 435-375-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: