JACK ENNIS (NPI# 1194773028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194773028 |
| Entity Type | Individual |
| Full Name | JACK ENNIS |
| Credential | PSYD, HSPP |
| Practice Address |
2160 N Illinois St Indianapolis IN 46202-1334 |
| Mailing Address |
Po Box 4323 Terre Haute IN 47804-0323 |
| Practice Telephone | 3179373700 |
| Practice Fax Number | 3179373710 |
| Mailing Telephone | 8122318323 |
| Mailing Fax Number | 8122318400 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2011-03-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20040742 | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200254160 | 05 |
| Street Address |
2160 N ILLINOIS ST |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-1334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033697149 | Mary Waling | Social Worker | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2018-07-31 |
| 1952823775 | Wendy Hill | Social Worker | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2017-07-13 |
| 1629512702 | Brittany Gipson | Social Worker | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2016-12-08 |
| 1366865230 | Elaine Sullivan | Counselor | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2014-01-29 |
| 1871924001 | Laura Griffis | Social Worker | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2013-12-13 |
| 1851662423 | Susan Grant | Social Worker | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2012-01-13 |
| 1407088842 | Sara Boyer | Psychologist | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2009-08-19 |
| 1639260110 | Masooma A Sheikh | Psychiatry & Neurology | 2160 N Illinois St, Indianapolis, IN 46202-1334 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841816048 | Christina E Maxwell Phd | Psychologist | 6337 Hollister Driive, Suite 101, Indianapolis, IN 46224-2996 | 2020-06-23 |
| 1902362619 | Geoffrey Edwards Buck | Psychologist | 9245 N Meridian St # 111, Indianapolis, IN 46260-1836 | 2019-02-18 |
| 1285128850 | Abigail Cole | Psychologist | 6314 Rucker Rd Ste A, Indianapolis, IN 46220-4800 | 2018-06-18 |
| 1558864538 | April Krowel | Psychologist | 7962 Oaklandon Rd Ste 109, Indianapolis, IN 46236 | 2018-03-15 |
| 1720515893 | Josie Gronbach | Psychologist | 50 E 91st St Ste 316, Indianapolis, IN 46240-1556 | 2017-05-18 |
| 1821469891 | Emma Carter | Psychologist | 603 E Washington St Fl 9, Indianapolis, IN 46204 | 2015-10-15 |
| 1316385081 | Megan A Orr | Psychologist | 2001 W 86th St Fl 7, Indianapolis, IN 46260-1902 | 2013-06-04 |
| 1255775490 | Psychservices Indiana LLC | Psychologist | 5924 1/2 Hillside Avenue East Dr, Indianapolis, IN 46220-2414 | 2013-04-18 |
| 1740557206 | Michael Eric O'brien | Psychologist | 5336 Elmwood Ave, Indianapolis, IN 46203-6023 | 2011-11-28 |
| 1114237336 | Greenhouse and Associates Inc. | Psychologist | 3016 Lake Shore Drive, Ste E, Indianapolis, IN 46205 | 2010-10-21 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46202 |
Please comment or provide details below to improve the information on JACK ENNIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.