Provider Demographics
NPI:1386849701
Name:HENRY, MARJORIE JUNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:JUNE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GATHE DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6214
Mailing Address - Country:US
Mailing Address - Phone:805-786-4143
Mailing Address - Fax:
Practice Address - Street 1:1800 GATHE DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6214
Practice Address - Country:US
Practice Address - Phone:805-801-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist