Provider Demographics
NPI:1669560876
Name:HENRY, DOUGLAS WAYNE (LPC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:HENRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-1015
Mailing Address - Country:US
Mailing Address - Phone:419-864-2940
Mailing Address - Fax:
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1055
Practice Address - Country:US
Practice Address - Phone:419-947-4560
Practice Address - Fax:419-947-2956
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-00004768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health