Healthcare Provider Details

I. General information

NPI: 1225335854
Provider Name (Legal Business Name): JENNIFER A. HENRY MS, MFT-I, CPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W. CHEYENNE AVE SUITE #10
LAS VEGAS NV
89031
US

IV. Provider business mailing address

4368 DUCK HARBOR AVE
NORTH LAS VEGAS NV
89031-4201
US

V. Phone/Fax

Practice location:
  • Phone: 702-633-5096
  • Fax: 702-633-7028
Mailing address:
  • Phone: 702-525-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMI1171
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: