Provider Demographics
NPI:1073805677
Name:HENDRESON, FREDDIE (LPC)
Entity Type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:
Last Name:HENDRESON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 N OWASSO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-3921
Mailing Address - Country:US
Mailing Address - Phone:918-587-0180
Mailing Address - Fax:
Practice Address - Street 1:2224 N OWASSO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-3921
Practice Address - Country:US
Practice Address - Phone:918-587-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health