Provider Demographics
NPI:1700013117
Name:HENRY, PHILIP J (PH D)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:J
Last Name:HENRY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7288
Mailing Address - Country:US
Mailing Address - Phone:561-967-6379
Mailing Address - Fax:561-439-3769
Practice Address - Street 1:6201 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7288
Practice Address - Country:US
Practice Address - Phone:561-967-6379
Practice Address - Fax:561-439-3769
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6052103T00000X, 101YP1600X, 103TC1900X
FLPY6052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling