Healthcare Provider Details

I. General information

NPI: 1497337570
Provider Name (Legal Business Name): HENDERSON BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27TH AVE
FT LAUDERDALE FL
33312-2051
US

IV. Provider business mailing address

4740 N STATE ROAD 7 STE 201
LAUDERDALE LAKES FL
33319-5839
US

V. Phone/Fax

Practice location:
  • Phone: 954-497-3856
  • Fax: 954-497-2901
Mailing address:
  • Phone: 954-881-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROL LOMAN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 954-497-3856