Provider Demographics
NPI:1336308790
Name:HENRY, JO A (MA)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:A
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N CENTRE CITY PKWY STE M
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1347
Mailing Address - Country:US
Mailing Address - Phone:760-419-8487
Mailing Address - Fax:760-749-7630
Practice Address - Street 1:2150 N CENTRE CITY PKWY STE M
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1347
Practice Address - Country:US
Practice Address - Phone:760-419-8487
Practice Address - Fax:760-749-7630
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103812106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist