MEDICARE: DR. THOMAS BRUCE MCHENRY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	19110052A	IN

General Provider Information

NPI Number	:	1023024445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS BRUCE MCHENRY PH.D.

Provider Business Mailing Address
First Line	:	1011 OAKHURST DR
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-2213
Country	:	US
Telephone Number	:	765-463-6716
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 E SUNSET LN
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-2456
Country	:	US
Telephone Number	:	765-404-6583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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