Provider Demographics
NPI:1982089017
Name:HENRY, MERYL (MS, LMFTA)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAKE ST S STE 222
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6461
Mailing Address - Country:US
Mailing Address - Phone:425-246-6835
Mailing Address - Fax:
Practice Address - Street 1:150 LAKE ST S STE 222
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6461
Practice Address - Country:US
Practice Address - Phone:425-246-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60481060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist