Provider Demographics
NPI:1821239559
Name:HENRY, DENISE ELLA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELLA
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7714
Mailing Address - Country:US
Mailing Address - Phone:314-774-2169
Mailing Address - Fax:
Practice Address - Street 1:626 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-7714
Practice Address - Country:US
Practice Address - Phone:314-774-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical