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General NPI Number Information
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NPI Number | 1467395251
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Entity Type | Individual
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Provider Name | PHYLICIA JOY HENDERSON LAC
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Gender | Female
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 1820 E RAY RD
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City | CHANDLER
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State | AZ
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Zip | 85225-8720
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Country | US
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Telephone | 928-295-0667
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 272
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City | YUMA
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State | AZ
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Zip | 85366-2312
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Country | US
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Telephone | 928-295-0667
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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 | LAC-23441
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License Number State | AZ
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