Provider Demographics
NPI:1043547805
Name:HENLE, JAIME REBECCA (PHD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:REBECCA
Last Name:HENLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ANNEX DR SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4867
Mailing Address - Country:US
Mailing Address - Phone:478-445-5736
Mailing Address - Fax:478-968-0698
Practice Address - Street 1:700 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2672
Practice Address - Country:US
Practice Address - Phone:954-290-7198
Practice Address - Fax:478-968-0698
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist