Provider Demographics
NPI:1093987968
Name:HENRY, PHILIP WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WAYNE
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1753
Mailing Address - Country:US
Mailing Address - Phone:717-261-7816
Mailing Address - Fax:717-263-4491
Practice Address - Street 1:62 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1753
Practice Address - Country:US
Practice Address - Phone:717-261-7816
Practice Address - Fax:717-263-4491
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000467106H00000X
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist