Provider Demographics
NPI:1982021085
Name:HENRY, BRIANNE C (MA)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:C
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:C
Other - Last Name:VORTHERMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:50 4TH AVE N APT 44B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1343
Mailing Address - Country:US
Mailing Address - Phone:612-750-0510
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2932
Practice Address - Country:US
Practice Address - Phone:612-750-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist