Provider Demographics
NPI:1164506952
Name:HENSON, LAURA SUE (PSYD LP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
Last Name:HENSON
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:CO BHSI LLC
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:6401 UNIVERSITY AVE NE
Practice Address - Street 2:BHSI LLC SUITE 304
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4344
Practice Address - Country:US
Practice Address - Phone:651-769-6250
Practice Address - Fax:651-769-6299
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9662597000Medicaid