Provider Demographics
NPI:1285180612
Name:HENRY, HEIDI (LPC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-4735
Mailing Address - Country:US
Mailing Address - Phone:724-787-4126
Mailing Address - Fax:
Practice Address - Street 1:1220 VINE ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-4735
Practice Address - Country:US
Practice Address - Phone:724-787-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010262101YP2500X
TX73860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional