Healthcare Provider Details

I. General information

NPI: 1164901195
Provider Name (Legal Business Name): ERIC J HENLEY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 1ST AVE STE 2325
PHOENIX AZ
85003-1933
US

IV. Provider business mailing address

101 N 1ST AVE STE 2325
PHOENIX AZ
85003-1933
US

V. Phone/Fax

Practice location:
  • Phone: 480-710-6435
  • Fax:
Mailing address:
  • Phone: 480-710-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15494
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: