Provider Demographics
NPI:1013314806
Name:HENRY, CARRIE (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9747
Mailing Address - Country:US
Mailing Address - Phone:937-408-2935
Mailing Address - Fax:
Practice Address - Street 1:4981 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9747
Practice Address - Country:US
Practice Address - Phone:937-408-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHI-24-1708103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool