Provider Demographics
NPI:1154486694
Name:HENRY, LAVONNE CATHERINEF
Entity Type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:CATHERINEF
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N 4TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4068
Mailing Address - Country:US
Mailing Address - Phone:402-379-4632
Mailing Address - Fax:402-379-4665
Practice Address - Street 1:123 N 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4068
Practice Address - Country:US
Practice Address - Phone:402-379-4632
Practice Address - Fax:402-379-4665
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1844101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251194-00Medicaid