Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 19110052A | IN |
NPI | 1023024445 |
---|---|
Provider Name | Dr. Thomas Bruce Mchenry |
First Address | West Lafayette Bra, IN 47906-2213 |
Second Address | West Lafayette Bra, IN 47906-2456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |