Provider Demographics
NPI:1225641673
Name:NOAH HENDERSON PHD MFT
Entity Type:Organization
Organization Name:NOAH HENDERSON PHD MFT
Other - Org Name:UNITED CHRISRTIAN COUNSELING CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:JAMEEL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MFT
Authorized Official - Phone:314-391-0248
Mailing Address - Street 1:231 S BEMISTON AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1925
Mailing Address - Country:US
Mailing Address - Phone:180-055-6376
Mailing Address - Fax:
Practice Address - Street 1:231 S BEMISTON AVE STE 800
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1925
Practice Address - Country:US
Practice Address - Phone:180-055-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0024589Medicaid