MEDICARE: MISTY LYNN HENCKE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4194	LA

General Provider Information

NPI Number	:	1215291786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY LYNN HENCKE LPC

Provider Business Mailing Address
First Line	:	1003 HUGH WALLIS RD S BLDG E
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-2528
Country	:	US
Telephone Number	:	337-534-8140
Fax Number	:	337-534-8141

Provider Business Practice Location Address
First Line	:	1003 HUGH WALLIS RD S BLDG E
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-2528
Country	:	US
Telephone Number	:	337-534-8140
Fax Number	:	337-534-8141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	10/04/2023

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