Provider Demographics
NPI:1083960470
Name:HENSLEE, ALAN JUSTIN (BHRS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JUSTIN
Last Name:HENSLEE
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3619
Mailing Address - Country:US
Mailing Address - Phone:580-271-0412
Mailing Address - Fax:
Practice Address - Street 1:311 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3619
Practice Address - Country:US
Practice Address - Phone:580-271-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health