Provider Demographics
NPI:1891923140
Name:HENRY, JAIME B (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:B
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3608
Mailing Address - Country:US
Mailing Address - Phone:847-492-1778
Mailing Address - Fax:847-492-0320
Practice Address - Street 1:906 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3608
Practice Address - Country:US
Practice Address - Phone:847-492-1778
Practice Address - Fax:847-492-0320
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist