Provider Demographics
NPI:1154715076
Name:ENNEKING, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ENNEKING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-3902
Mailing Address - Country:US
Mailing Address - Phone:520-850-7283
Mailing Address - Fax:
Practice Address - Street 1:5120 SW 31ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-3902
Practice Address - Country:US
Practice Address - Phone:520-261-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC 14549101Y00000X
KSLCPC-03104101YM0800X
AZLPC-17039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor