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General NPI Number Information
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NPI Number | 1972533271
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Entity Type | Organization
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Legal Business Name | HENDERSON BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 4740 N STATE ROAD 7 STE 201
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5839
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Country | US
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Telephone | 954-497-3850
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Fax | 954-497-3857
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Provider Business Mailing Address
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Address Line | 4740 N STATE ROAD 7 STE 201
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5804
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Country | US
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Telephone | 954-497-3850
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Fax | 954-497-3857
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Authorized Official
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Title or Position | CFO
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Name | ERICA RICKETTS
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Credential |
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Telephone | 954-777-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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