MEDICARE: MRS. JO A HENRY M.A.

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	106H00000X	Marriage & Family Therapist	103812	CA

General Provider Information

NPI Number	:	1336308790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JO A HENRY M.A.

Provider Business Mailing Address
First Line	:	2150 N CENTRE CITY PKWY STE M
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1347
Country	:	US
Telephone Number	:	760-419-8487
Fax Number	:	760-749-7630

Provider Business Practice Location Address
First Line	:	2150 N CENTRE CITY PKWY STE M
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1347
Country	:	US
Telephone Number	:	760-419-8487
Fax Number	:	760-749-7630

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

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	05/17/2019

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