Provider Demographics
NPI:1811957921
Name:HENNINGER, BETSY BROOKE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:BROOKE
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900245
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-0245
Mailing Address - Country:US
Mailing Address - Phone:801-634-8727
Mailing Address - Fax:801-733-4083
Practice Address - Street 1:326 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9691
Practice Address - Country:US
Practice Address - Phone:435-840-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5084755-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20-4382140OtherFEDERAL TAX ID#