Provider Demographics
NPI:1407983133
Name:HENRICH, JOHN R (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HENRICH
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MISSION HOUSE LANE
Mailing Address - Street 2:NORTH CENTRAL MINISTRY DEVELOPMENT CENTER
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2751
Mailing Address - Country:US
Mailing Address - Phone:651-636-5120
Mailing Address - Fax:651-636-5124
Practice Address - Street 1:516 MISSION HOUSE LANE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2751
Practice Address - Country:US
Practice Address - Phone:651-636-5120
Practice Address - Fax:651-636-5124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4223103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist