Provider Demographics
NPI:1033440060
Name:HENCH, MICHAEL JAMES (LMFT, MBA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:HENCH
Suffix:
Gender:M
Credentials:LMFT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 SANTA CLARA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5466
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:435-674-9309
Practice Address - Street 1:2711 SANTA CLARA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5466
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:435-674-9309
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5093144-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist