MEDICARE: DR. ROBERT J. HENLEY PH.D.

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	103T00000X	Psychologist	0439	AZ

General Provider Information

NPI Number	:	1861459745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J. HENLEY PH.D.

Provider Business Mailing Address
First Line	:	2255 W NORTHERN AVE
Second Line	:	SUITE B-111
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 W NORTHERN AVE
Second Line	:	SUITE B-111
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4936
Country	:	US
Telephone Number	:	602-864-6360
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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