Provider Demographics
NPI:1760799472
Name:HENRY, CHARLOTTE ELAINE (LMFT, BHRS)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELAINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMFT, BHRS
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ELAINE
Other - Last Name:BLAYLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11223 N PENN AVE APT 806
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7736
Mailing Address - Country:US
Mailing Address - Phone:405-503-1791
Mailing Address - Fax:
Practice Address - Street 1:11223 N PENN AVE APT 806
Practice Address - Street 2:3621 N. KELLY AVE.
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7736
Practice Address - Country:US
Practice Address - Phone:405-524-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X251B00000X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health