Provider Demographics
NPI:1629505029
Name:HENRY, STEVEN WESLEY (MFT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WESLEY
Last Name:HENRY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 VIA ACIANDO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4047
Mailing Address - Country:US
Mailing Address - Phone:805-312-0569
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 103
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3553
Practice Address - Country:US
Practice Address - Phone:805-267-0881
Practice Address - Fax:818-981-0649
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT17367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty