Provider Demographics
NPI:1508003948
Name:HENRY, GRACE MONIQUE (MA,LPC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MONIQUE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 FOREST RAIN LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4555
Mailing Address - Country:US
Mailing Address - Phone:713-240-3946
Mailing Address - Fax:281-459-3249
Practice Address - Street 1:4131 FOREST RAIN LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4555
Practice Address - Country:US
Practice Address - Phone:713-240-3946
Practice Address - Fax:281-459-3249
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X
TX63082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management