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General NPI Number Information
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NPI Number | 1538414628
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Entity Type | Individual
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Provider Name | MARTHA GAYNELLE HENSLEE-OLIVER LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | UTHSCH, 6431 FANNIN JJL332B
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City | HOUSTON
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State | TX
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Zip | 77030-0000
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Country | US
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Telephone | 713-500-6439
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Fax | 713-500-0543
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Provider Business Mailing Address
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Address Line | UT HEALTH, DEPT. OF PEDIATRICS, 6431 FANNIN JJL332B
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 713-500-6439
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Fax | 713-500-0543
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15894
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License Number State | TX
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