Provider Demographics
NPI:1437889540
Name:HENLEY, VANESSA RAELIN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAELIN
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 1:12201 CONRAD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6416
Mailing Address - Country:US
Mailing Address - Phone:512-944-7839
Mailing Address - Fax:
Practice Address - Street 1:12201 CONRAD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6416
Practice Address - Country:US
Practice Address - Phone:512-944-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician