Provider Demographics
NPI:1801235106
Name:HENRY, JANIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANIEL
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JANIEL
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 N INDIAN HILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4642
Mailing Address - Country:US
Mailing Address - Phone:909-603-9300
Mailing Address - Fax:
Practice Address - Street 1:114 N INDIAN HILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4642
Practice Address - Country:US
Practice Address - Phone:909-603-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical