Provider Demographics
NPI:1336864115
Name:HENNEY, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HENNEY
Suffix:
Gender:M
Credentials:
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 1484
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-1484
Mailing Address - Country:US
Mailing Address - Phone:502-222-2389
Mailing Address - Fax:502-222-2927
Practice Address - Street 1:4414 OLD LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:KY
Practice Address - Zip Code:40010-9547
Practice Address - Country:US
Practice Address - Phone:502-222-2389
Practice Address - Fax:502-222-2927
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276756101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)