Doctor Name: | GLENNA J HENSON |
NPI Number: | 1114247244 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | 1561 |
Business Practice Address: | 15500 Ky Route 979 Beaver, KY - 416049026 |
Business Phone Number: | 6062055016 |
Business Fax Number: | |
Mailing Address: | 15500 Ky Route 979, BEAVER |
State: | KY |
Postal Code: | 416049026 |
Phone Number: | 6062055016 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2010 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1561 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |