Provider Demographics
NPI:1487196325
Name:HENSON, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:HENSON
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 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1200
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:201 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2607
Practice Address - Country:US
Practice Address - Phone:918-225-0540
Practice Address - Fax:918-225-0536
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor