Provider Demographics
NPI:1306500400
Name:HENRY, MEGAN RENAE (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENAE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N KOLB RD STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4099
Mailing Address - Country:US
Mailing Address - Phone:520-838-0918
Mailing Address - Fax:
Practice Address - Street 1:2055 N KOLB RD STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4099
Practice Address - Country:US
Practice Address - Phone:520-838-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-19573OtherLICENSE