Provider Demographics
NPI:1366503971
Name:HENDERSON, SHIRLEY JOHNSON (LMHC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JOHNSON
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 45TH STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-842-9550
Mailing Address - Fax:561-842-9114
Practice Address - Street 1:2151 45TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2026
Practice Address - Country:US
Practice Address - Phone:561-842-9550
Practice Address - Fax:561-842-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28451OtherBCBS