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General NPI Number Information
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NPI Number | 1609643220
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Entity Type | Individual
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Provider Name | AMY LEE HENDERSON P-LPC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 7145 SWINNEA RD STE 2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6380
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Country | US
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Telephone | 901-590-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 2927 GEOFFREY DR
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City | SOUTHAVEN
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State | MS
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Zip | 38672-8110
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Country | US
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Telephone | 662-538-8326
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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 | P-1022
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License Number State | MS
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