MEDICARE: ALEXIS HENDERSON LCSW

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255491064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS HENDERSON LCSW

Provider Business Mailing Address
First Line	:	3275 LAKESHORE DR
Second Line	:
City	:	WASHOE VALLEY
State	:	NV
Zip	:	89704
Country	:	US
Telephone Number	:	775-849-3434
Fax Number	:	775-849-3435

Provider Business Practice Location Address
First Line	:	3275 LAKESHORE DR
Second Line	:
City	:	WASHOE VALLEY
State	:	NV
Zip	:	89704
Country	:	US
Telephone Number	:	775-849-3434
Fax Number	:	775-849-3435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	11/01/2010

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