MEDICARE: TRACEY LYNETTE CAMPBELL HENDERSON RN

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	101YM0800X	Mental Health Counselor
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	1214661	TX

General Provider Information

NPI Number	:	1568982635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY LYNETTE CAMPBELL HENDERSON RN

Provider Business Mailing Address
First Line	:	PO BOX 630164
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75963-0164
Country	:	US
Telephone Number	:	936-205-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 N 31ST AVE STE C262
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9630
Country	:	US
Telephone Number	:	602-754-0400
Fax Number	:

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	12/12/2025

Similar Medicare Providers

1255914842 — MR. AHMED T ALI
Practice Location Address:

10000 N 31ST AVE STE C264
PHOENIX, AZ
85051-9630

Practice Phone: 205-207-7777
Practice Fax:

1053467571 — DANIELA REID MD
Practice Location Address:

3540 E BASELINE RD STE 150
PHOENIX, AZ
85042-9630

Practice Phone: 602-323-3000
Practice Fax: 602-243-5390

1124374806 — TRACY THURSTON MC, LPC
Practice Location Address:

3540 E BASELINE RD STE 150
PHOENIX, AZ
85042-9630

Practice Phone: 602-323-3000
Practice Fax:

1386037729 — ADAM KIMBALL GENO MSN, PMHNP-BC
Practice Location Address:

3540 E BASELINE RD STE 150
PHOENIX, AZ
85042-9630

Practice Phone: 602-685-6000
Practice Fax: 602-243-5390

1255716783 — BALJINDER KAUR FNP- BC, PMHNP- BC
Practice Location Address:

3540 E BASELINE RD STE 150
PHOENIX, AZ
85042-9630

Practice Phone: 602-323-3000
Practice Fax: 602-243-5390

1609251057 — LIFEWELL BEHAVIORAL WELLNESS
Practice Location Address:

3540 E BASELINE RD , SUITE 150
PHOENIX, AZ
85042-9630

Practice Phone: 602-808-2800
Practice Fax: 602-808-2799

Directions to “ TRACEY LYNETTE CAMPBELL HENDERSON RN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.