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NPI Code Detail

MEDICARE: THE HENDERSON CLINIC LLC

MEDICARE: THE HENDERSON CLINIC LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)MS

General Provider Information

NPI Number : 1275726614
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE HENDERSON CLINIC LLC
Provider Business Mailing Address
First Line : 359 TOWNE CENTER BLVD
Second Line : SUITE 601
City : RIDGELAND
State : MS
Zip : 39157-4868
Country : US
Telephone Number : 601-572-8686
Fax Number : 601-572-8685
Provider Business Practice Location Address
First Line : 359 TOWNE CENTER BLVD
Second Line : SUITE 601
City : RIDGELAND
State : MS
Zip : 39157-4868
Country : US
Telephone Number : 601-572-8686
Fax Number : 601-572-8685
Authorized Official
Title or Position : MANAGING MEMBER
Name : DR. ELIZABETH CONNELL HENDERSON
Credential : MD
Telephone Number : 601-572-8686
Provider Enumeration Date : 08/20/2007
Last Update Date : 08/20/2007

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Directions to “THE HENDERSON CLINIC LLC ” Practice Location

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