The holder whose full name is ENNIS, JACK EDWARD,come from Avon IN,hold the Psychologist - Health Service Provider license(NO.20040742A) which status is Active.
| Name | ENNIS, JACK EDWARD |
|---|---|
| License Number | 20040742A |
| License Type | Psychologist - Health Service Provider |
| License Status | Active |
| City | Avon |
| State | IN |