Provider Demographics
NPI:1083761241
Name:HENDERSON, HAROLD JORDAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:JORDAN
Last Name:HENDERSON
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 1:1075 CHECK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8047
Mailing Address - Country:US
Mailing Address - Phone:907-357-1629
Mailing Address - Fax:907-357-1639
Practice Address - Street 1:1075 CHECK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8047
Practice Address - Country:US
Practice Address - Phone:907-357-1629
Practice Address - Fax:907-357-1639
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health