Provider Demographics
NPI:1083832976
Name:HENRY, RYAN GLENN (PHD, LMFT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:GLENN
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 ASHLEY OAKS CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6426
Mailing Address - Country:US
Mailing Address - Phone:813-333-6200
Mailing Address - Fax:813-907-8066
Practice Address - Street 1:2204 ASHLEY OAKS CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6426
Practice Address - Country:US
Practice Address - Phone:813-333-6200
Practice Address - Fax:813-907-8066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist