Healthcare Provider Details

I. General information

NPI: 1245516806
Provider Name (Legal Business Name): BARBARA K. HENRY LCSW, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 FREMONT ST
KIEL WI
53042-1423
US

IV. Provider business mailing address

PO BOX 305
KIEL WI
53042-0305
US

V. Phone/Fax

Practice location:
  • Phone: 920-894-7900
  • Fax: 920-894-7900
Mailing address:
  • Phone: 920-894-7900
  • Fax: 920-894-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number506123
License Number StateWI

VIII. Authorized Official

Name: BARBARA K. HENRY
Title or Position: PRESIDENT
Credential:
Phone: 920-898-5951