Provider Demographics
NPI:1740512664
Name:HENRIE, JAMES RUSSELL (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:HENRIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RUSS
Other - Middle Name:
Other - Last Name:HENRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:59-215 KE NUI RD APT C
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9601
Mailing Address - Country:US
Mailing Address - Phone:808-778-5084
Mailing Address - Fax:
Practice Address - Street 1:59-215 KE NUI RD APT C
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9601
Practice Address - Country:US
Practice Address - Phone:808-778-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist