Healthcare Provider Details

I. General information

NPI: 1568072163
Provider Name (Legal Business Name): SHELBY HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S LINCOLN AVE STE 1
YORK NE
68467-4242
US

IV. Provider business mailing address

1123 N 9TH ST
BEATRICE NE
68310-2041
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-6128
  • Fax: 402-362-7012
Mailing address:
  • Phone: 402-228-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: