Provider Demographics
NPI:1073910741
Name:HENKE PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:HENKE PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-214-7442
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-0661
Mailing Address - Country:US
Mailing Address - Phone:701-214-7442
Mailing Address - Fax:701-751-5705
Practice Address - Street 1:2372 HARMON LN N
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8271
Practice Address - Country:US
Practice Address - Phone:701-214-7442
Practice Address - Fax:701-751-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9938 ND2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty