Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 203303 | ID |
Y | 103TC0700X | Clinical Psychologist | 203303 | ID |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TH0100X | Health Service | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 103TS0200X | School Psychologist |
NPI | 1447516984 |
---|---|
Provider Name | Dr. Brandon J. Henscheid |
First Address | Afton, WY 83110-0214 |
Second Address | Afton, WY 83110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 21/04/2020 |