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NPI Code Detail

MEDICARE: TRACY ANN HENDERSON MA, BHT

MEDICARE: TRACY ANN HENDERSON MA, BHT
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1235535873
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY ANN HENDERSON MA, BHT
Provider Business Mailing Address
First Line : 202 E EARLL DR
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85012-2647
Country : US
Telephone Number : 602-599-5404
Fax Number : 602-599-5704
Provider Business Practice Location Address
First Line : 3222 N 37TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-6304
Country : US
Telephone Number : 602-599-5475
Fax Number : 602-522-8338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 11/10/2014

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