Provider Demographics
NPI:1538464573
Name:HENDERSON, BONITA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:
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 1:3700 WEST KILGORE AVE.
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4810
Mailing Address - Country:US
Mailing Address - Phone:765-289-5437
Mailing Address - Fax:765-213-5094
Practice Address - Street 1:3700 W. KILGORE AVE.
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4810
Practice Address - Country:US
Practice Address - Phone:765-289-5437
Practice Address - Fax:765-213-5094
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001846A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health