MEDICARE: MRS. NELIDA HENDERSON LMHC, NCC

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	103K00000X	Behavior Analyst
2	1041C0700X	Clinical Social Worker
3	171M00000X	Case Manager/Care Coordinator
4	101YM0800X	Mental Health Counselor	MH11920	FL

General Provider Information

NPI Number	:	1255691101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NELIDA HENDERSON LMHC, NCC

Provider Business Mailing Address
First Line	:	2301 NE 22ND TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-2619
Country	:	US
Telephone Number	:	305-389-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W OAKLAND PARK BLVD # 410-9
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1388
Country	:	US
Telephone Number	:	305-389-5581
Fax Number	:

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

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/05/2020

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