Provider Demographics
NPI:1154640365
Name:WINTER, HENRY WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WILLIAM
Last Name:WINTER
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:PO BOX 3751
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-3751
Mailing Address - Country:US
Mailing Address - Phone:714-832-3688
Mailing Address - Fax:714-832-9829
Practice Address - Street 1:14081 YORBA STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-832-3688
Practice Address - Fax:714-832-9829
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist