MEDICARE: MRS. HILARY B HENSON MFT

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	106H00000X	Marriage & Family Therapist	MFC35771	CA

General Provider Information

NPI Number	:	1447430350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HILARY B HENSON MFT

Provider Business Mailing Address
First Line	:	PO BOX 40324
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-6324
Country	:	US
Telephone Number	:	562-434-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 E 6TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1010
Country	:	US
Telephone Number	:	562-882-1337
Fax Number	:

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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