Provider Demographics
NPI:1922247162
Name:DANIEL K. EHNIS, PC
Entity type:Organization
Organization Name:DANIEL K. EHNIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:EHNIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:616-975-3160
Mailing Address - Street 1:4670 E. FULTON
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8409
Mailing Address - Country:US
Mailing Address - Phone:616-975-3160
Mailing Address - Fax:616-975-3163
Practice Address - Street 1:4670 E. FULTON
Practice Address - Street 2:SUITE 101
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8409
Practice Address - Country:US
Practice Address - Phone:616-975-3160
Practice Address - Fax:616-975-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6635103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN8907001Medicare PIN
MIN8907001Medicare UPIN