Provider Demographics
NPI:1659449387
Name:HENDERSON, BRIAN K (LMHC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:N BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-1448
Mailing Address - Country:US
Mailing Address - Phone:978-930-9393
Mailing Address - Fax:978-663-3345
Practice Address - Street 1:235 BILLERICA RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3628
Practice Address - Country:US
Practice Address - Phone:978-930-9393
Practice Address - Fax:978-663-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5226101YM0800X
MA1214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist