1760799472 NPI number — CHARLOTTE ELAINE HENRY LMFT, BHRS

Table of content: CHARLOTTE ELAINE HENRY LMFT, BHRS (NPI 1760799472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760799472 NPI number — CHARLOTTE ELAINE HENRY LMFT, BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
CHARLOTTE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, BHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLAYLOCK
Provider Other First Name:
CHARLOTTE
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1760799472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11223 N PENN AVE APT 806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-7736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-503-1791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11223 N PENN AVE APT 806
Provider Second Line Business Practice Location Address:
3621 N. KELLY AVE.
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-7736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-524-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  251B00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com