Provider Demographics
NPI:1134198369
Name:HENRY, NORMAN R (PHD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:R
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 CLARK CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3436
Mailing Address - Country:US
Mailing Address - Phone:615-885-0099
Mailing Address - Fax:615-871-4026
Practice Address - Street 1:2620 PENNINGTON BEND RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-1108
Practice Address - Country:US
Practice Address - Phone:615-885-0099
Practice Address - Fax:615-871-4026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R68757Medicare UPIN
3582224Medicare ID - Type Unspecified