Provider Demographics
NPI:1538414628
Name:HENSLEE-OLIVER, MARTHA GAYNELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:GAYNELLE
Last Name:HENSLEE-OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GAY
Other - Middle Name:
Other - Last Name:HENSLEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:UT HEALTH, DEPT. OF PEDIATRICS, 6431 FANNIN
Mailing Address - Street 2:JJL332B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-6439
Mailing Address - Fax:713-500-0543
Practice Address - Street 1:UTHSCH, 6431 FANNIN
Practice Address - Street 2:JJL332B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-0000
Practice Address - Country:US
Practice Address - Phone:713-500-6439
Practice Address - Fax:713-500-0543
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical