Provider Demographics
NPI:1629477823
Name:MCHENRY, ERIK RYAN
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:RYAN
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 W 4805 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1177
Mailing Address - Country:US
Mailing Address - Phone:801-955-9110
Mailing Address - Fax:801-955-9411
Practice Address - Street 1:1760 W 4805 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1177
Practice Address - Country:US
Practice Address - Phone:801-955-9110
Practice Address - Fax:801-955-9411
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker