Provider Demographics
NPI:1265041115
Name:HENDERSON, TAMATHY (LPCC)
Entity Type:Individual
Prefix:
First Name:TAMATHY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 GREENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9724
Mailing Address - Country:US
Mailing Address - Phone:502-779-0354
Mailing Address - Fax:
Practice Address - Street 1:129B HOWELL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3614
Practice Address - Country:US
Practice Address - Phone:270-234-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional