Provider Demographics
NPI:1033549415
Name:HENRY, BRANDEN (PHDMA, LPC, LMFTA)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHDMA, LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 LAKE COUNTY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9544
Mailing Address - Country:US
Mailing Address - Phone:501-270-9326
Mailing Address - Fax:877-994-5569
Practice Address - Street 1:14 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4190
Practice Address - Country:US
Practice Address - Phone:601-780-7400
Practice Address - Fax:877-994-5569
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST10467A106H00000X
MS1821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist