Provider Demographics
NPI:1255685814
Name:HENLEY, JOAN GAIL (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:GAIL
Last Name:HENLEY
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4843
Mailing Address - Country:US
Mailing Address - Phone:870-219-0755
Mailing Address - Fax:
Practice Address - Street 1:2116 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4843
Practice Address - Country:US
Practice Address - Phone:870-219-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1052269103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst