Provider Demographics
NPI:1770778268
Name:HENRY, LOUISE MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 KERNEYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2947
Mailing Address - Country:US
Mailing Address - Phone:863-802-5744
Mailing Address - Fax:
Practice Address - Street 1:203 KERNEYWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2947
Practice Address - Country:US
Practice Address - Phone:863-802-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health