Provider Demographics
NPI:1336636299
Name:HENNE, CAREY LYNN
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:LYNN
Last Name:HENNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAREY
Other - Middle Name:LYNN
Other - Last Name:HENNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:MC GILL
Mailing Address - State:NV
Mailing Address - Zip Code:89318-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 AVE B
Practice Address - Street 2:
Practice Address - City:MCGILL
Practice Address - State:NV
Practice Address - Zip Code:89318
Practice Address - Country:US
Practice Address - Phone:702-354-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid