Active NPI
Jacqueline Henry, PHD
- Psychologist
- Jefferson City, MO
National Provider Identifier
1962448696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 33758
- Practice address
- 3702 W Truman Blvd
Suite 115
Jefferson City, MO 65109-4970 - Phone
- (573) 634-5303
- Fax
- (573) 761-6888
- NPI assigned
- Jun 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 33758 | MO | Primary |
Addresses
Primary practice location
3702 W Truman Blvd
Suite 115
Jefferson City, MO 65109-4970
Mailing address
308 Binder Dr
Jefferson City, MO 65109-0817
Phone (573) 638-2658
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33758 | Other | MO | STATE LICENSES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33758 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962448696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 BINDER DR",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651090817",
"telephone_number": "573-638-2658",
"fax_number": "573-761-6888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3702 W TRUMAN BLVD",
"address_2": "SUITE 115",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651094970",
"telephone_number": "573-634-5303",
"fax_number": "573-761-6888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "33758",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSES",
"identifier": "33758",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.