Basic Information
| Provider Information | |||||||||
| NPI: | 1972976199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENSELMAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC, CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8212 S MARCH POINT RD | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982218684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605882800 | ||||||||
| FaxNumber: | 3665882808 | ||||||||
| Practice Location | |||||||||
| Address1: | 8212 S. MARCH POINT ROAD | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605882800 | ||||||||
| FaxNumber: | 3665882808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2015 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MC 60644116 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | CO 60569345 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | CP60712530 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LH60840470 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.