Provider Demographics
NPI:1992402424
Name:ENSOR, JOHN H (MED, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:ENSOR
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1589
Mailing Address - Country:US
Mailing Address - Phone:573-875-8880
Mailing Address - Fax:573-442-3830
Practice Address - Street 1:90 E LESLIE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1589
Practice Address - Country:US
Practice Address - Phone:573-875-8880
Practice Address - Fax:573-442-3830
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018032591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional