Provider Demographics
NPI:1659741478
Name:HENRY, KATY
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CIVIC CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5295
Mailing Address - Country:US
Mailing Address - Phone:510-671-0777
Mailing Address - Fax:510-685-0377
Practice Address - Street 1:1450 CIVIC CT
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5295
Practice Address - Country:US
Practice Address - Phone:510-671-0777
Practice Address - Fax:510-685-0377
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor