Provider Demographics
NPI:1700809118
Name:HENLEY, CHERYL (MS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:HENLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E SUPERIOR ST . #101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2104
Mailing Address - Country:US
Mailing Address - Phone:218-726-5433
Mailing Address - Fax:218-279-2844
Practice Address - Street 1:230 E SUPERIOR ST . #101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2104
Practice Address - Country:US
Practice Address - Phone:218-726-5433
Practice Address - Fax:218-279-2844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLP0359103TA0700X
MNLP0359103TB0200X, 103TC0700X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist