Provider Demographics
NPI:1467731877
Name:HENRY, JENNIFER M (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:CANADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:3352 N FUTRALL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4057
Mailing Address - Country:US
Mailing Address - Phone:479-521-1427
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:10301 MAYO DR
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-1660
Practice Address - Country:US
Practice Address - Phone:479-494-5700
Practice Address - Fax:479-478-6213
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor