Healthcare Provider Details

I. General information

NPI: 1972454528
Provider Name (Legal Business Name): HENDERSON BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 JACKSON ST
HOLLYWOOD FL
33020-5021
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: 954-486-4005
  • Fax: 954-497-3857
Mailing address:
  • Phone: 954-486-4005
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL LOMAN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 954-486-4005