Provider Demographics
NPI:1912541921
Name:ENSO MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:ENSO MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARYE
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, QMHP, NC
Authorized Official - Phone:605-519-5850
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-0922
Mailing Address - Country:US
Mailing Address - Phone:695-519-5850
Mailing Address - Fax:
Practice Address - Street 1:211 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2646
Practice Address - Country:US
Practice Address - Phone:605-519-5850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)