Provider Demographics
NPI:1003048141
Name:HENNESSEY, CAROLYN ANN (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3304
Mailing Address - Country:US
Mailing Address - Phone:541-281-3738
Mailing Address - Fax:
Practice Address - Street 1:401 E 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3304
Practice Address - Country:US
Practice Address - Phone:541-281-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist