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General NPI Number Information
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NPI Number | 1871468157
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Entity Type | Individual
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Provider Name | BROOKE HENDERSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 302 S SPRING ST
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City | TUPELO
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State | MS
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Zip | 38804-4853
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Country | US
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Telephone | 662-205-0098
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Fax | 662-495-4079
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | TUPELO
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State | MS
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Zip | 38802-0068
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Country | US
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Telephone | 622-205-0098
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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 | 10801
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License Number State | MS
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