Provider Demographics
NPI:1194020958
Name:ENNIS, BETTY KAY (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:KAY
Last Name:ENNIS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8589 N FARM ROAD 157
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HOPE
Mailing Address - State:MO
Mailing Address - Zip Code:65725-9143
Mailing Address - Country:US
Mailing Address - Phone:417-763-0979
Mailing Address - Fax:
Practice Address - Street 1:8589 N FARM ROAD 157
Practice Address - Street 2:
Practice Address - City:PLEASANT HOPE
Practice Address - State:MO
Practice Address - Zip Code:65725-9143
Practice Address - Country:US
Practice Address - Phone:417-763-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional