Colin Ennis, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008031 Issued in IL

Practice address

53 W Jackson Blvd
635
Chicago, IL 60604-3606

Phone

(312) 725-9745

Fax

(312) 488-3642

NPI assigned

Dec 2, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 4, 2019 through Jun 4, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colin F. Ennis PSYD LLC

  • Community/Behavioral Health Agency
  • Chicago, IL
  • NPI 1588942312
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407888000000",
    "number": "1881996320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 N LAKE SHORE DR",
            "address_2": "515",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572874",
            "telephone_number": "312-725-9745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 W JACKSON BLVD",
            "address_2": "635",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043606",
            "telephone_number": "312-725-9745",
            "fax_number": "312-488-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "COLIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-02",
        "last_updated": "2014-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Enliven Couples Therapy
• Enliven Couples Therapy, Inc.
• Enliven Wellness Center LLC
• Gabrielle Enna
• Stephanie Ennen, LCPC
• Jennifer Lynn Ennis, M.D.
• Patrick Kevin Ennis, MD
• William J Ennis, D.O.
• Kirsten Enoch, LCSW
• Owen Enoch, MA

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.