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NPI Code Detail

MEDICARE: MR. GLEN ALAN ENSINGER MSED

MEDICARE: MR. GLEN ALAN ENSINGER MSED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180.004733IL

General Provider Information

NPI Number : 1205144466
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GLEN ALAN ENSINGER MSED
Provider Business Mailing Address
First Line : 1 KALISA WAY STE 101
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3508
Country : US
Telephone Number : 888-948-6789
Fax Number :
Provider Business Practice Location Address
First Line : 1338 PHAY AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2311
Country : US
Telephone Number : 309-221-5602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2010
Last Update Date : 05/09/2024

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