Provider Demographics
NPI:1871310334
Name:HENSLEY, ALICE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6568
Mailing Address - Country:US
Mailing Address - Phone:260-579-5277
Mailing Address - Fax:
Practice Address - Street 1:4814 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-5461
Practice Address - Country:US
Practice Address - Phone:260-431-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1551866103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool