Provider Demographics
NPI:1043547052
Name:HENNING, MARYJANE A (MS, LMFT, LADC, NCC)
Entity type:Individual
Prefix:MS
First Name:MARYJANE
Middle Name:A
Last Name:HENNING
Suffix:
Gender:F
Credentials:MS, LMFT, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 W SAHARA AVE
Mailing Address - Street 2:105G27
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5772
Mailing Address - Country:US
Mailing Address - Phone:702-339-1165
Mailing Address - Fax:702-685-0543
Practice Address - Street 1:6875 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1671
Practice Address - Country:US
Practice Address - Phone:702-339-1165
Practice Address - Fax:702-685-0549
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1207101YA0400X
NV01091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)