1669412177 NPI number — SUSAN H MCHENRY

Table of content: (NPI 1669412177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669412177 NPI number — SUSAN H MCHENRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN H MCHENRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPEN HEART CHRISTIAN COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669412177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13104 POPLAR HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20601-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-751-2058
Provider Business Mailing Address Fax Number:
301-632-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13104 POPLAR HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20601-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-751-2058
Provider Business Practice Location Address Fax Number:
301-632-9595
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCHENRY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
HENDERSON
Authorized Official Title or Position:
OWNER / THERAPIST
Authorized Official Telephone Number:
301-751-2058

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10508 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2273367 . This is a "CIGNA BEHAVIORAL PROV NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100089335 . This is a "APS HEALTHCARE PROV NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1133183 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 217-64-9471 . This is a "TRICARE PRIME PROV NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 371103 . This is a "MHN PROVIDER NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 239C,64703301 . This is a "BCBS OF MD PROVIDER NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5677 . This is a "BCBS FEDERAL PROVIDER NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5677 . This is a "BCBS OF DC PROVIDER NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 217649471 . This is a "TRICARE STANDARD PPO NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 740207 . This is a "NCPPO PROVIDER NUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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