Provider Demographics
NPI:1427284140
Name:HENRY, MICHELE L (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 E 50TH ST
Mailing Address - Street 2:UNIT 2C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3128
Mailing Address - Country:US
Mailing Address - Phone:708-288-5643
Mailing Address - Fax:773-952-7524
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 421
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:708-288-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health