Provider Demographics
NPI:1477607604
Name:HENDERSON, KAREN SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450551
Mailing Address - Street 2:5219 MCPHERSON, SUITE 406, LAREDO, TX 78041
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0013
Mailing Address - Country:US
Mailing Address - Phone:956-337-6996
Mailing Address - Fax:956-725-3166
Practice Address - Street 1:5219 MCPHERSON RD
Practice Address - Street 2:406
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7306
Practice Address - Country:US
Practice Address - Phone:956-337-6996
Practice Address - Fax:956-725-3166
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32211103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609940Medicare PIN