Provider Demographics
NPI:1669604187
Name:HENINGER, MICHAEL BYRNE (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BYRNE
Last Name:HENINGER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4351
Mailing Address - Country:US
Mailing Address - Phone:214-857-2496
Mailing Address - Fax:
Practice Address - Street 1:1305 W MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4351
Practice Address - Country:US
Practice Address - Phone:817-921-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0050791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical