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General NPI Number Information
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NPI Number | 1588942312
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Entity Type | Organization
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Legal Business Name | COLIN F. ENNIS PSYD LLC
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE SUITE 711
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City | CHICAGO
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State | IL
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Zip | 60601-3901
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Country | US
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Telephone | 312-725-9745
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Fax | 312-488-3642
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Provider Business Mailing Address
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Address Line | 3450 N LAKE SHORE DR #515
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City | CHICAGO
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State | IL
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Zip | 60657-2874
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Country | US
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Telephone | 312-725-9745
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Fax | 312-488-3642
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLIN F ENNIS
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Credential | PSYD
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Telephone | 312-725-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 071-008031
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License Number State | IL
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