Provider Demographics
NPI:1679740070
Name:HENRY, MARION RUTH
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:RUTH
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 1:127 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2114
Mailing Address - Country:US
Mailing Address - Phone:724-349-4494
Mailing Address - Fax:
Practice Address - Street 1:1176 GRANT ST
Practice Address - Street 2:SUITE 2220
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2870
Practice Address - Country:US
Practice Address - Phone:724-349-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC00219101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC002619OtherLICENSED PROFEFSSIONAL COUNSELOR