MR. KEITH MCPHERSON ENNIS (NPI# 1356714430) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356714430 |
| Entity Type | Individual |
| Full Name | MR. KEITH MCPHERSON ENNIS |
| Credential | CADC-CS CACS5100518 |
| Practice Address |
3636 N 1st St Ste 135&154 Fresno CA 93726-6800 |
| Mailing Address |
3636 N. First St. # 135 Fresno CA 93726 |
| Practice Telephone | 5592251464 |
| Practice Fax Number | 5592251693 |
| Mailing Telephone | 5592251464 |
| Mailing Fax Number | 5592251693 |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2018-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609203421 | Keith Ennis | Counselor | 13 Temple St, Quincy, MA 02169-5110 | 2013-10-11 |
| 1033292628 | Keith Ennis | Family Medicine | 1907 W Sycamore St, Kokomo, IN 46901-5148 | 2006-10-24 |
| Street Address |
3636 N 1ST ST STE 135&154 |
| City | FRESNO |
| State | CA |
| Zip Code | 93726-6800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154541332 | Traci Summerlin | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2007-04-27 |
| 1578084265 | Ronald A Evans | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2017-07-03 |
| 1417493552 | Brittani Anne Fanciullo | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2017-01-12 |
| 1992248546 | Moses Robert Soza Sr. | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2016-11-30 |
| 1760851687 | Michelle Lynn Turk | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2015-09-21 |
| 1609254945 | Frank Vasquez Jr. | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2015-05-07 |
| 1477967479 | Turning Point of Central California Inc. | Community/Behavioral Health | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2014-06-17 |
| 1366709925 | Santos Robert Duque | Counselor | 3636 N 1st St Ste 135&154, Fresno, CA 93726-6800 | 2012-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528520814 | Tania Grijalva Miranda | Behavior Technician | 4910 E. Ashland Ave, Fresno, CA 93726 | 2019-04-04 |
| 1790249894 | Lags Spine and Sportscare Medical Centers, Inc. | Psychologist | 3751 E Shields Avenue, Fresno, CA 93726 | 2019-01-23 |
| 1013481100 | Jill A Perricone | Respiratory Therapist, Registered | 4785 N First St, Fresno, CA 93726 | 2019-01-11 |
| 1285108399 | Leann Lokelani Benton | Respiratory Therapist, Registered | 4785 N. First St, Fresno, CA 93726 | 2019-01-11 |
| 1548745912 | Alina Gonzalez | Counselor | 4440 N. First St., Fresno, CA 93726 | 2018-10-01 |
| 1336622067 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 3751 E Shields Ave, Fresno, CA 93726 | 2018-09-10 |
| 1730676206 | Joanne K Groves | Counselor | 3636 N. First Street, St. 123, Fresno, CA 93726 | 2018-04-19 |
| 1356865679 | Fresno Mental Psychological Health Services, P.C. | Clinic/Center | 4021 N Fresno Street, Ste. 101, Fresno, CA 93726 | 2017-07-28 |
| 1205358819 | Jetinder Singh Ghag | Counselor | 3636 N.first St # 135 and 154, Fresno, CA 93726 | 2017-07-14 |
| 1164897328 | Karam Um Dds Inc | Dentist | 4747 N. First St. #174, Fresno, CA 93726 | 2015-12-14 |
| Find all providers in zip 93726 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022976 | Denise Renee Hands | Counselor | 4604 E Terrace Ave, Fresno, CA 93703-2079 | 2020-10-30 |
| 1649807694 | Debbie Jeneen Darden | Counselor | 891 W Kearney Blvd, Fresno, CA 93706-2514 | 2020-03-26 |
| 1205466802 | Elizabeth C Esqueda | Counselor | 804 S Parallel Ave, Fresno, CA 93721-2404 | 2020-01-22 |
| 1295378446 | Caussaundra Maria Dominguez | Counselor | 2772 S Martin Luther King, Fresno, CA 93706 | 2019-10-21 |
| 1881244945 | Aurelio Mendoza | Counselor | 1414 W. Kearney Blvd, Fresno, CA 93706 | 2019-09-19 |
| 1356994909 | Joaquin Sanchez | Counselor | Quest House 2731 W Olive Ave, Fresno, CA 93728 | 2019-07-23 |
| 1003374539 | Jasmine Elizabeth Flores | Counselor | 2772 S Martin Luther King Junior Blvd, Fresno, CA 93706 | 2019-03-04 |
| 1104397348 | Brian K Bradley | Counselor | 2212 N Winery Ave, Fresno, CA 93703-2896 | 2018-12-16 |
| 1063982049 | Bruno Sivongxay | Counselor | 2772 South Martin L King Jr Blvd, Fresno, CA 93706 | 2018-12-03 |
| 1831669951 | Ashlee Faith Vasquez | Counselor | 1900 N Gateway Blvd Ste 100, Fresno, CA 93727-1622 | 2018-12-01 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.