Provider Demographics
NPI:1285647024
Name:HENSLEY, DAVID B (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 COMMERCE ST STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5510
Mailing Address - Country:US
Mailing Address - Phone:361-570-1444
Mailing Address - Fax:361-570-1446
Practice Address - Street 1:2002 COMMERCE ST STE C
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5510
Practice Address - Country:US
Practice Address - Phone:361-570-1444
Practice Address - Fax:361-570-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016BGMedicare ID - Type Unspecified