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General NPI Number Information
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NPI Number | 1477022614
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Entity Type | Organization
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Legal Business Name | ENSO WELLNESS INC
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 2014 GREEN ST REAR
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City | HARRISBURG
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State | PA
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Zip | 17102-2127
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Country | US
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Telephone | 717-836-1184
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Fax | 717-754-0017
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Provider Business Mailing Address
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Address Line | 2016 GREEN ST
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City | HARRISBURG
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State | PA
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Zip | 17102-2127
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Country | US
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Telephone | 717-836-1184
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIA TILLEY
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Credential | LCSW
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Telephone | 717-836-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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