Healthcare Provider Details

I. General information

NPI: 1649371212
Provider Name (Legal Business Name): NORMAN E. HENDRICKSEN PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W. ENTERPRISE
CLOVIS CA
93619-8357
US

IV. Provider business mailing address

P.O. BOX 27763
FRESNO CA
93729-1031
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-9734
  • Fax: 559-499-1232
Mailing address:
  • Phone: 559-499-1233
  • Fax: 559-499-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberOPL59380
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: