Provider Demographics
NPI:1497046627
Name:HENRY, MARLY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:JEAN
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1849
Mailing Address - Country:US
Mailing Address - Phone:702-222-0034
Mailing Address - Fax:702-222-0659
Practice Address - Street 1:5447 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1849
Practice Address - Country:US
Practice Address - Phone:702-222-0034
Practice Address - Fax:702-222-0659
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01791-C251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical