Provider Demographics
NPI:1437650496
Name:HENDERSON, ANDREW B
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3834
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:970-252-3208
Practice Address - Street 1:107 W 11TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1811
Practice Address - Country:US
Practice Address - Phone:970-874-8981
Practice Address - Fax:970-874-4169
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health