Provider Demographics
NPI:1023024445
Name:MCHENRY, THOMAS BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRUCE
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47906-2213
Mailing Address - Country:US
Mailing Address - Phone:765-463-6716
Mailing Address - Fax:
Practice Address - Street 1:255 E SUNSET LN
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-2456
Practice Address - Country:US
Practice Address - Phone:765-404-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN19110052A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling