Provider Demographics
NPI:1700955069
Name:HENRY, JANICE T (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:T
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:LYNN
Other - Last Name:THORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2465 E PLACITA DE LA VICTORIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1213
Mailing Address - Country:US
Mailing Address - Phone:520-603-6120
Mailing Address - Fax:
Practice Address - Street 1:2465 E PLACITA DE LA VICTORIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1213
Practice Address - Country:US
Practice Address - Phone:520-603-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional