Provider Demographics
NPI:1619667110
Name:HENLEY, TRINETTE R (LPC)
Entity Type:Individual
Prefix:
First Name:TRINETTE
Middle Name:R
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 CRITERION AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2623
Mailing Address - Country:US
Mailing Address - Phone:314-265-6914
Mailing Address - Fax:
Practice Address - Street 1:12140 CRITERION AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2623
Practice Address - Country:US
Practice Address - Phone:314-265-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022041793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional