MEDICARE: HENDERSON BEHAVIORAL HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1154272706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	4740 N STATE ROAD 7 STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5839
Country	:	US
Telephone Number	:	954-486-4005
Fax Number	:	954-497-3857

Provider Business Practice Location Address
First Line	:	4720 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5860
Country	:	US
Telephone Number	:	954-486-4005
Fax Number	:	954-497-3857

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	CAROL LOMAN
Credential	:
Telephone Number	:	954-486-4005

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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