Provider Demographics
NPI:1053834101
Name:HENDERSON, KATHI NANETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:NANETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHI
Other - Middle Name:
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2135 LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2822
Mailing Address - Country:US
Mailing Address - Phone:559-259-2333
Mailing Address - Fax:
Practice Address - Street 1:4545 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0946
Practice Address - Country:US
Practice Address - Phone:559-229-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47123106H00000X
CA47123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist