Provider Demographics
NPI:1104117712
Name:HENRY, MIRIAM E (LMHC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:E
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:130 S PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5232
Mailing Address - Country:US
Mailing Address - Phone:407-644-0367
Mailing Address - Fax:407-644-0367
Practice Address - Street 1:130 S PHELPS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5232
Practice Address - Country:US
Practice Address - Phone:407-644-0367
Practice Address - Fax:407-644-0367
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health