Active NPI
Tracy Ennis
- Addiction (Substance Use Disorder) Counselor
- Chandler, AZ
National Provider Identifier
1366028219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 908A W Chandler Blvd
Chandler, AZ 85225-4903 - Phone
- (480) 899-0200
- NPI assigned
- Mar 22, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
908A W Chandler Blvd
Chandler, AZ 85225-4903
Mailing address
908A W Chandler Blvd
Chandler, AZ 85225-4903
Phone (480) 899-0200
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616371200000",
"number": "1366028219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908A W CHANDLER BLVD",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852254903",
"telephone_number": "480-899-0200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "908A W CHANDLER BLVD",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852254903",
"telephone_number": "480-899-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "TRACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-22",
"last_updated": "2021-03-22",
"certification_date": "2021-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.