Provider Demographics
NPI:1326874173
Name:HENRY, MICHALA Y
Entity type:Individual
Prefix:
First Name:MICHALA
Middle Name:Y
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 N EASTMAN RD APT D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3343
Mailing Address - Country:US
Mailing Address - Phone:903-309-0222
Mailing Address - Fax:
Practice Address - Street 1:1517 N EASTMAN RD APT D
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3343
Practice Address - Country:US
Practice Address - Phone:903-309-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management