Healthcare Provider Details

I. General information

NPI: 1558886291
Provider Name (Legal Business Name): SCHERRI NICOLE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

IV. Provider business mailing address

3257 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

V. Phone/Fax

Practice location:
  • Phone: 901-590-4106
  • Fax: 901-343-0792
Mailing address:
  • Phone: 901-618-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3642
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: