Provider Demographics
NPI:1073976742
Name:HENSON, AMBERLEE K (PSYD)
Entity Type:Individual
Prefix:
First Name:AMBERLEE
Middle Name:K
Last Name:HENSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMBERLEE
Other - Middle Name:K
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E MAUD ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3249
Mailing Address - Country:US
Mailing Address - Phone:352-253-9348
Mailing Address - Fax:352-253-9351
Practice Address - Street 1:101 E MAUD ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3249
Practice Address - Country:US
Practice Address - Phone:352-253-9348
Practice Address - Fax:352-253-9351
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9334103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling