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NPI Code Detail

MEDICARE: MR. BUSTER LAMONTE HENDERSON

MEDICARE: MR. BUSTER LAMONTE HENDERSON
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3172V00000XCommunity Health Worker
4372600000XAdult Companion

General Provider Information

NPI Number : 1871622522
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BUSTER LAMONTE HENDERSON
Provider Business Mailing Address
First Line : 6950 65TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2316
Country : US
Telephone Number : 916-393-1222
Fax Number :
Provider Business Practice Location Address
First Line : 6950 65TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2316
Country : US
Telephone Number : 916-393-1222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 06/09/2025

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