Healthcare Provider Details

I. General information

NPI: 1316855331
Provider Name (Legal Business Name): CARLIE MCKEEHAN HENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 ROSECRANS AVE
FULLERTON CA
92833-1912
US

IV. Provider business mailing address

6200 HOLLYWOOD BLVD APT 4506
LOS ANGELES CA
90028-6397
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7785
  • Fax: 714-447-7556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139330
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number260137773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: