Healthcare Provider Details

I. General information

NPI: 1568570026
Provider Name (Legal Business Name): THEODORE ALAN HENDERSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3979 E ARAPAHOE RD STE 205
CENTENNIAL CO
80122-2072
US

IV. Provider business mailing address

3979 E ARAPAHOE RD STE 205
CENTENNIAL CO
80122-2072
US

V. Phone/Fax

Practice location:
  • Phone: 720-493-1101
  • Fax: 720-493-1107
Mailing address:
  • Phone: 720-493-1101
  • Fax: 720-493-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number37438
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number37438
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37438
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: