Provider Demographics
NPI:1336274786
Name:HENSLEY, ROY L (CATC)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:L
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:MR
Other - First Name:ROY
Other - Middle Name:L
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AA
Mailing Address - Street 1:2180 S EUNICE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-4312
Mailing Address - Country:US
Mailing Address - Phone:559-266-3791
Mailing Address - Fax:559-486-3146
Practice Address - Street 1:405 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1513
Practice Address - Country:US
Practice Address - Phone:559-486-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100045AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)