Provider Demographics
NPI:1083953699
Name:HENRY, MARK ALLAN (MS LPC CANDIDATE)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLAN
Last Name:HENRY
Suffix:
Gender:M
Credentials:MS LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVANT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3916
Mailing Address - Country:US
Mailing Address - Phone:580-323-3322
Mailing Address - Fax:580-323-6233
Practice Address - Street 1:600 AVANT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3916
Practice Address - Country:US
Practice Address - Phone:580-323-3322
Practice Address - Fax:580-323-6233
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health