Provider Demographics
NPI:1336306661
Name:HENLEY, ELIZABETH ANN
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:HENLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 S 4TH AVE
Mailing Address - Street 2:BLDG 3 STE104
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7236
Mailing Address - Country:US
Mailing Address - Phone:928-329-9313
Mailing Address - Fax:928-329-9719
Practice Address - Street 1:2755 S 4TH AVE
Practice Address - Street 2:BLDG 3 STE 104
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7236
Practice Address - Country:US
Practice Address - Phone:928-329-9313
Practice Address - Fax:928-329-9719
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ623357385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child