Provider Demographics
NPI:1669573143
Name:ENSIGN, JOHN STEWART (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEWART
Last Name:ENSIGN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 F ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4111
Mailing Address - Country:US
Mailing Address - Phone:530-304-0711
Mailing Address - Fax:530-297-2609
Practice Address - Street 1:433 F ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4111
Practice Address - Country:US
Practice Address - Phone:530-304-0711
Practice Address - Fax:530-297-2609
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical