Provider Demographics
NPI:1174830897
Name:HENRIKSON, BRENT ALEXANDER (MS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALEXANDER
Last Name:HENRIKSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 AUBURN BLVD
Mailing Address - Street 2:BLDG. #3
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0359
Mailing Address - Country:US
Mailing Address - Phone:916-722-6100
Mailing Address - Fax:916-722-9229
Practice Address - Street 1:8421 AUBURN BLVD
Practice Address - Street 2:BLDG. #3
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0359
Practice Address - Country:US
Practice Address - Phone:916-722-6100
Practice Address - Fax:916-722-9229
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF64110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist