Provider Demographics
NPI:1346401825
Name:HENDERSON, PHYLLIS JEAN
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 CRESSWELL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5914
Mailing Address - Country:US
Mailing Address - Phone:817-689-8465
Mailing Address - Fax:
Practice Address - Street 1:7304 CRESSWELL DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5914
Practice Address - Country:US
Practice Address - Phone:817-689-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator