Provider Demographics
NPI:1609643220
Name:HENDERSON, AMY LEE (P-LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 GEOFFREY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8110
Mailing Address - Country:US
Mailing Address - Phone:662-538-8326
Mailing Address - Fax:
Practice Address - Street 1:7145 SWINNEA RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6380
Practice Address - Country:US
Practice Address - Phone:901-590-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health