Provider Demographics
NPI:1770758567
Name:ALYSON HENRY PHD P.C.
Entity type:Organization
Organization Name:ALYSON HENRY PHD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-507-6868
Mailing Address - Street 1:111 N. WABASH AVE
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3133
Mailing Address - Country:US
Mailing Address - Phone:773-507-6868
Mailing Address - Fax:
Practice Address - Street 1:111 N. WABASH AVE
Practice Address - Street 2:SUITE 1021
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3133
Practice Address - Country:US
Practice Address - Phone:773-507-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty