Provider Demographics
NPI:1912072307
Name:HENLEY, JANE ELLEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELLEN
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LMFT
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 2141
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-2141
Mailing Address - Country:US
Mailing Address - Phone:208-725-4049
Mailing Address - Fax:208-725-4049
Practice Address - Street 1:333 SOUTH MAIN ST.
Practice Address - Street 2:SUITE 212
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-2141
Practice Address - Country:US
Practice Address - Phone:208-725-4049
Practice Address - Fax:208-725-4049
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID#8106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist