Provider Demographics
NPI:1326488313
Name:HENRY, GEORGE KAHLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KAHLE
Last Name:HENRY
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 1:31816 SEAFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-2637
Mailing Address - Country:US
Mailing Address - Phone:310-457-0777
Mailing Address - Fax:310-457-0777
Practice Address - Street 1:1950 SAWTELLE BLVD STE 342
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7074
Practice Address - Country:US
Practice Address - Phone:310-457-0777
Practice Address - Fax:310-457-0777
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical