Provider Demographics
NPI:1144776246
Name:ENNEY, KATIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:ENNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2898 ROWENA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2020
Mailing Address - Country:US
Mailing Address - Phone:818-583-7134
Mailing Address - Fax:
Practice Address - Street 1:2898 ROWENA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2020
Practice Address - Country:US
Practice Address - Phone:818-583-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist