MEDICARE: CRYSTAL TERESE HENSON MA

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	103TC0700X	Clinical Psychologist	268285	KY
2	103TC0700X	Clinical Psychologist	3824	TN

General Provider Information

NPI Number	:	1922136001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL TERESE HENSON MA

Provider Business Mailing Address
First Line	:	1735 SPRINGFIELD HWY
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-9191
Country	:	US
Telephone Number	:	615-310-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3981
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:	574-546-1999

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/19/2024

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Directions to “ CRYSTAL TERESE HENSON MA” Practice Location

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