Provider Demographics
NPI:1912327578
Name:ENNIS, RACHEAL MARIE (LMFT, MA)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:MARIE
Last Name:ENNIS
Suffix:
Gender:F
Credentials:LMFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 DUNCAN AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6700
Mailing Address - Country:US
Mailing Address - Phone:310-404-7224
Mailing Address - Fax:
Practice Address - Street 1:1050 DUNCAN AVE
Practice Address - Street 2:SUITE K
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6700
Practice Address - Country:US
Practice Address - Phone:310-404-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist