Provider Demographics
NPI:1164547147
Name:HENSON, JAMES ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALAN
Last Name:HENSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:A
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW PC
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0550
Mailing Address - Country:US
Mailing Address - Phone:541-389-7045
Mailing Address - Fax:541-389-7045
Practice Address - Street 1:965 S W EMKAY DRIVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-0550
Practice Address - Country:US
Practice Address - Phone:541-389-7045
Practice Address - Fax:541-389-7045
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S29429Medicare UPIN
7012776785Medicare ID - Type Unspecified