Provider Demographics
NPI:1558662452
Name:HENRY, NANCY JM (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JM
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:RM 1R052
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2101
Mailing Address - Country:US
Mailing Address - Phone:801-581-6228
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:RM 1R052
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2101
Practice Address - Country:US
Practice Address - Phone:801-581-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5196121-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical