Provider Demographics
NPI:1679602361
Name:EHNIS, DANIEL KEITH (EDD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEITH
Last Name:EHNIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 FULTON ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8455
Mailing Address - Country:US
Mailing Address - Phone:616-975-3160
Mailing Address - Fax:616-975-3163
Practice Address - Street 1:4670 FULTON ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8455
Practice Address - Country:US
Practice Address - Phone:616-975-3160
Practice Address - Fax:616-975-3163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006635103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN89070001Medicare ID - Type Unspecified