Provider Demographics
NPI:1225335854
Name:HENRY, JENNIFER A (MS, MFT-I, CPC-I)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, MFT-I, CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 DUCK HARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4201
Mailing Address - Country:US
Mailing Address - Phone:702-525-7864
Mailing Address - Fax:
Practice Address - Street 1:570 W. CHEYENNE AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031
Practice Address - Country:US
Practice Address - Phone:702-633-5096
Practice Address - Fax:702-633-7028
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI1171101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101Y00000XMedicaid