Provider Demographics
NPI:1992957500
Name:HENSLIN, EARL R (PSYD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:R
Last Name:HENSLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 S BREA BLVD STE 23
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5365
Mailing Address - Country:US
Mailing Address - Phone:714-256-2807
Mailing Address - Fax:
Practice Address - Street 1:745 S BREA BLVD STE 23
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5365
Practice Address - Country:US
Practice Address - Phone:714-256-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist