Provider Demographics
NPI:1215553110
Name:HENRY, MARGARET K (MS,LCPC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:K
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:HENRY-GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2210
Mailing Address - Country:US
Mailing Address - Phone:618-326-2772
Mailing Address - Fax:618-937-1440
Practice Address - Street 1:2311 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-5912
Practice Address - Country:US
Practice Address - Phone:618-547-6703
Practice Address - Fax:618-549-3734
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL180.016764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2970Medicaid