Provider Demographics
NPI:1225619364
Name:HENDRICKSON, HARRY EUGENE JR
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:EUGENE
Last Name:HENDRICKSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ROSEDALE LN E
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-2559
Mailing Address - Country:US
Mailing Address - Phone:270-399-5784
Mailing Address - Fax:
Practice Address - Street 1:280 ROSEDALE LN E
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-2559
Practice Address - Country:US
Practice Address - Phone:270-399-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health