Healthcare Provider Details

I. General information

NPI: 1164547147
Provider Name (Legal Business Name): JAMES ALAN HENSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES A HENSON LCSW PC

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S W EMKAY DRIVE
BEND OR
97701-0550
US

IV. Provider business mailing address

PO BOX 550
BEND OR
97709-0550
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7045
  • Fax: 541-389-7045
Mailing address:
  • Phone: 541-389-7045
  • Fax: 541-389-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberOR00032
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: