Provider Demographics
NPI:1003357518
Name:HENLEY, EMMY LU (PHD, RDN, LD, CEDRD)
Entity Type:Individual
Prefix:MRS
First Name:EMMY
Middle Name:LU
Last Name:HENLEY
Suffix:
Gender:F
Credentials:PHD, RDN, LD, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5860
Mailing Address - Country:US
Mailing Address - Phone:806-370-3755
Mailing Address - Fax:
Practice Address - Street 1:6520 UNIVERSITY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413
Practice Address - Country:US
Practice Address - Phone:806-370-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81284133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered