MEDICARE: MATTHEW MORGAN HENDERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	20050	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235280744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MORGAN HENDERSON LCSW

Provider Business Mailing Address
First Line	:	4912 PERSHING PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1202
Country	:	US
Telephone Number	:	210-274-6609
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 DUNCAN AVE STE 201
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1103
Country	:	US
Telephone Number	:	210-274-6609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	12/12/2023

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