MEDICARE: TERESA HENSON 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
1	101YP2500X	Professional Counselor	3402	OK

General Provider Information

NPI Number	:	1811287741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA HENSON LLC

Provider Business Mailing Address
First Line	:	1608 SW 67TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-3208
Country	:	US
Telephone Number	:	405-570-4396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 SW 67TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-3208
Country	:	US
Telephone Number	:	405-570-4396
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	TERESA ANN HENSON
Credential	:	MHR, LPC, ATR
Telephone Number	:	405-570-4396

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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