Provider Demographics
NPI:1336310648
Name:HENDERSON, LISA ANNE (MA, EDS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 E FORT LOWELL RD
Mailing Address - Street 2:#D
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-7307
Mailing Address - Country:US
Mailing Address - Phone:520-232-8444
Mailing Address - Fax:
Practice Address - Street 1:3645 E PIMA ST
Practice Address - Street 2:CATALINA HIGH SCHOOL
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3320
Practice Address - Country:US
Practice Address - Phone:520-232-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool