Provider Demographics
NPI:1932162112
Name:HENNING, DOUGLAS JAMES (MS, LP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
Last Name:HENNING
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3703
Mailing Address - Country:US
Mailing Address - Phone:320-762-1511
Mailing Address - Fax:
Practice Address - Street 1:700 CEDAR ST
Practice Address - Street 2:STE 154
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1769
Practice Address - Country:US
Practice Address - Phone:320-762-2400
Practice Address - Fax:320-762-8047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN93473OtherUBH
MN319J5HEOtherBLUECROSS/BLUESHIELD
MN928011023605OtherPREFERREDONE
MNHP19617OtherHEALTHPARTNERS