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General NPI Number Information
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NPI Number | 1487465837
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Entity Type | Individual
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Provider Name | MAKENZIE HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 911 E CENTENNIAL DR
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City | PITTSBURG
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State | KS
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Zip | 66762-6601
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Country | US
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Telephone | 620-231-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 313 S HUGH ST
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City | FRONTENAC
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State | KS
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Zip | 66763-2203
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Country | US
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Telephone | 620-687-4266
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 03380-T
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License Number State | KS
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