MEDICARE: JOHN H ENSOR MED, LPC

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
1	101YP2500X	Professional Counselor	2018032591	MO

General Provider Information

NPI Number	:	1992402424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H ENSOR MED, LPC

Provider Business Mailing Address
First Line	:	90 E LESLIE LN
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-1589
Country	:	US
Telephone Number	:	573-875-8880
Fax Number	:	573-442-3830

Provider Business Practice Location Address
First Line	:	90 E LESLIE LN
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-1589
Country	:	US
Telephone Number	:	573-875-8880
Fax Number	:	573-442-3830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	01/16/2025

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