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General NPI Number Information
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NPI Number | 1043463714
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Entity Type | Individual
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Provider Name | MICHAEL RAY HENRY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 831 ALAMO DR STE 6B
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City | VACAVILLE
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State | CA
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Zip | 95688
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Country | US
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Telephone | 707-624-9767
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Fax | 707-471-4140
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Provider Business Mailing Address
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Address Line | PO BOX 5235 6271 PLEASANTS VALLEY ROAD
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City | VACAVILLE
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State | CA
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Zip | 95696-5235
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Country | US
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Telephone | 858-449-6301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3321
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9724
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22614
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License Number State | CA
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