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General NPI Number Information
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NPI Number | 1285308767
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Entity Type | Individual
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Provider Name | THOMAS EDWARD HENDERSON M.A.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1964 HOWELL BRANCH RD STE 106
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City | WINTER PARK
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State | FL
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Zip | 32792-1042
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Country | US
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Telephone | 407-657-5800
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Fax | 407-657-4249
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Provider Business Mailing Address
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Address Line | 455 ROCKY BROOK CT
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City | CASSELBERRY
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State | FL
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Zip | 32707-5230
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Country | US
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Telephone | 407-584-7179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23551
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License Number State | FL
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