Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1034 | NM |
Y | 103T00000X | Psychologist | 1034 | NM |
NPI | 1003909730 |
---|---|
Provider Name | Kay E. Ennis |
First Address | Las Cruces, NM 88005-4352 |
Second Address | Las Cruces, NM 88005-4352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 07/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NM600035 | VALUE OPTIONS (01) | NM |