Provider Demographics
NPI:1356520217
Name:HENRY, JAMES EDGAR (RESIDENTAL COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDGAR
Last Name:HENRY
Suffix:
Gender:M
Credentials:RESIDENTAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3528
Mailing Address - Country:US
Mailing Address - Phone:503-289-0465
Mailing Address - Fax:
Practice Address - Street 1:7214 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3528
Practice Address - Country:US
Practice Address - Phone:503-289-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion