Provider Demographics
NPI:1225654429
Name:HENDERSON, AMY M (LPC,CPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC,CPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:AGUINAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPC
Mailing Address - Street 1:331 WAKETON RD
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3051
Mailing Address - Country:US
Mailing Address - Phone:214-558-8272
Mailing Address - Fax:
Practice Address - Street 1:2000 HIGHLAND VILLAGE RD STE C
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-8105
Practice Address - Country:US
Practice Address - Phone:214-558-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80875101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional