Provider Demographics
NPI:1619925930
Name:HENRY, SHIRLEY (LPC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:HENRY
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 1:735 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1113
Mailing Address - Country:US
Mailing Address - Phone:573-783-8875
Mailing Address - Fax:573-783-8890
Practice Address - Street 1:735 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1113
Practice Address - Country:US
Practice Address - Phone:573-783-8875
Practice Address - Fax:573-783-8890
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health