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General NPI Number Information
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NPI Number | 1811389620
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Entity Type | Individual
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Provider Name | HOLLY JO HENDERSON L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 1701 TOWNSEND ST
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City | CASSVILLE
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State | MO
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Zip | 65625-1451
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Country | US
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Telephone | 417-671-8075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 221
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City | CAPE FAIR
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State | MO
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Zip | 65624-0221
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Country | US
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Telephone | 417-559-0135
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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 | 2015002776
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License Number State | MO
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