Provider Demographics
NPI:1417499013
Name:HENSHAW, AUBREYANNA M (QMHA; CADC-R)
Entity Type:Individual
Prefix:MRS
First Name:AUBREYANNA
Middle Name:M
Last Name:HENSHAW
Suffix:
Gender:F
Credentials:QMHA; CADC-R
Other - Prefix:MS
Other - First Name:AUBREYANNA
Other - Middle Name:M
Other - Last Name:MCCUTCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:3425 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1340
Mailing Address - Country:US
Mailing Address - Phone:541-523-7400
Mailing Address - Fax:541-523-4927
Practice Address - Street 1:3425 13TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1340
Practice Address - Country:US
Practice Address - Phone:541-523-7400
Practice Address - Fax:541-523-4927
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-19-369-101YA0400X
OR19-QMHA-I-02569106S00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty