Active NPI
Donald L Ennis, PH D
- Psychologist
- Garland, TX
National Provider Identifier
1194849083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3127
- Practice address
- 514 Fairway Lakes Dr
Garland, TX 75044-5043 - Phone
- (469) 450-5539
- NPI assigned
- Mar 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3127 | TX | Primary |
Addresses
Primary practice location
514 Fairway Lakes Dr
Garland, TX 75044-5043
Mailing address
PO Box 496763
Garland, TX 75049-6763
Phone (469) 450-5539
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00F89C | Other | TX | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3127 | TX | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196985600000",
"number": "1194849083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 496763",
"city": "GARLAND",
"state": "TX",
"postal_code": "750496763",
"telephone_number": "469-450-5539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 FAIRWAY LAKES DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750445043",
"telephone_number": "469-450-5539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "DONALD",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-18",
"last_updated": "2007-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "3127",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "00F89C",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.