Provider Demographics
NPI:1053968123
Name:HENSON, DENNIS LEROY (MFT)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEROY
Last Name:HENSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 BLUE VENICE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2515
Mailing Address - Country:US
Mailing Address - Phone:702-378-1555
Mailing Address - Fax:
Practice Address - Street 1:7945 BLUE VENICE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2515
Practice Address - Country:US
Practice Address - Phone:702-378-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250005979Medicaid