Provider Demographics
NPI:1366793903
Name:HENRY, KAREN D (MS, LPC,CSAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, LPC,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N GRAND AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4841
Mailing Address - Country:US
Mailing Address - Phone:262-999-8656
Mailing Address - Fax:262-821-6180
Practice Address - Street 1:741 N GRAND AVE STE 302
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4841
Practice Address - Country:US
Practice Address - Phone:262-999-8656
Practice Address - Fax:262-821-6180
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16010-132101YA0400X
WI5034-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI152851198Medicaid