Provider Demographics
NPI:1811370257
Name:HENSON, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:HENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FREEPORT BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6274
Mailing Address - Country:US
Mailing Address - Phone:775-685-0156
Mailing Address - Fax:877-205-5692
Practice Address - Street 1:50 FREEPORT BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6274
Practice Address - Country:US
Practice Address - Phone:775-685-0156
Practice Address - Fax:877-205-5692
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst