Provider Demographics
NPI:1467685529
Name:HENRY, SARA LOUISE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3717
Mailing Address - Country:US
Mailing Address - Phone:239-287-8493
Mailing Address - Fax:
Practice Address - Street 1:3400 TAMIAMI TRL N
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3717
Practice Address - Country:US
Practice Address - Phone:239-287-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2327106H00000X
CA35605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist