Provider Demographics
NPI:1205137148
Name:HENRIFARRY, JUDITH CAROL (LMFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAROL
Last Name:HENRIFARRY
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:PO BOX 131018
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-8980
Mailing Address - Country:US
Mailing Address - Phone:909-800-8848
Mailing Address - Fax:909-866-8580
Practice Address - Street 1:41943 BIG BEAR BLVD., SUITE 227
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-8980
Practice Address - Country:US
Practice Address - Phone:909-800-8848
Practice Address - Fax:909-866-8580
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist