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General NPI Number Information
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NPI Number | 1467519652
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Entity Type | Individual
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Provider Name | KAREN ANN HENDERSON MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 214 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-351-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W LOGAN ST
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City | HARRISBURG
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State | IL
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Zip | 62946-1218
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Country | US
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Telephone | 618-253-8127
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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 |
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License Number State |
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