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NPI Code Detail

MEDICARE: NATALIE ENNIS LAC

MEDICARE: NATALIE ENNIS LAC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1518821941
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATALIE ENNIS LAC
Provider Business Mailing Address
First Line : 350 SALEM RD STE 1
Second Line :
City : CONWAY
State : AR
Zip : 72034-6166
Country : US
Telephone Number : 501-336-8300
Fax Number :
Provider Business Practice Location Address
First Line : 350 SALEM RD STE 1
Second Line :
City : CONWAY
State : AR
Zip : 72034-6166
Country : US
Telephone Number : 501-336-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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Directions to “ NATALIE ENNIS LAC” Practice Location

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