Provider Demographics
NPI:1801051396
Name:HENRY, LISA J (LMSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 GREENSPOINT DR
Mailing Address - Street 2:#915
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2435
Mailing Address - Country:US
Mailing Address - Phone:469-328-8810
Mailing Address - Fax:
Practice Address - Street 1:5785 GREENSPOINT DR
Practice Address - Street 2:#915
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2435
Practice Address - Country:US
Practice Address - Phone:469-328-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26057104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker