Provider Demographics
NPI:1366690331
Name:HENDERSON, JILL P (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:P
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 N COLLINS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2699
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:972-690-9309
Practice Address - Street 1:2099 N COLLINS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2699
Practice Address - Country:US
Practice Address - Phone:972-437-4698
Practice Address - Fax:972-690-9309
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health