Provider Demographics
NPI:1851307201
Name:HENRY-BUHK, STEPHANIE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HENRY-BUHK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W SOUTH BOUNDARY ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1763
Mailing Address - Country:US
Mailing Address - Phone:419-931-0260
Mailing Address - Fax:419-931-0261
Practice Address - Street 1:134 W SOUTH BOUNDARY ST
Practice Address - Street 2:SUITE N
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1763
Practice Address - Country:US
Practice Address - Phone:419-931-0260
Practice Address - Fax:419-931-0261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0257770Medicaid
OH000000481679OtherANTHEM
OH04362OtherPARAMOUNT INSURANCE
OH0257770Medicaid