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General NPI Number Information
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NPI Number | 1477311066
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Entity Type | Individual
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Provider Name | REBECCA MARIE HENDERSON LAC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 12351 E BRADSHAW MOUNTAIN RD UNIT 176
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City | DEWEY
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State | AZ
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Zip | 86327-6070
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Country | US
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Telephone | 714-274-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 12351 E BRADSHAW MOUNTAIN RD UNIT 176
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City | DEWEY
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State | AZ
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Zip | 86327-6070
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Country | US
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Telephone | 714-274-2590
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LAC-22641
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-22641
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License Number State | AZ
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