Provider Demographics
NPI:1902492895
Name:ENNIS, CHELSEA RHIANON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:RHIANON
Last Name:ENNIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 BRAINARD ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1503
Mailing Address - Country:US
Mailing Address - Phone:901-832-1577
Mailing Address - Fax:
Practice Address - Street 1:2400 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6535
Practice Address - Country:US
Practice Address - Phone:504-507-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical