Provider Demographics
NPI:1457702292
Name:HENSLEY, FELICE SUZANNE
Entity Type:Individual
Prefix:
First Name:FELICE
Middle Name:SUZANNE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 S STATE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5815
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:
Practice Address - Street 1:775 S STATE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5815
Practice Address - Country:US
Practice Address - Phone:707-463-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health