Provider Demographics
NPI:1477614204
Name:HENRY, LORENE H (MD)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:H
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 ROCK PRAIRIE ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8358
Mailing Address - Country:US
Mailing Address - Phone:979-696-5883
Mailing Address - Fax:979-696-6596
Practice Address - Street 1:1605 ROCK PRAIRIE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-696-5883
Practice Address - Fax:979-696-6596
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG51652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23339Medicare UPIN