Provider Demographics
NPI:1710514971
Name:HENDERSON, JOY TAMBERLIN
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:TAMBERLIN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E ROOSEVELT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3998
Mailing Address - Country:US
Mailing Address - Phone:217-737-1833
Mailing Address - Fax:
Practice Address - Street 1:4112 FIELDSTONE RD SUITE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6182
Practice Address - Country:US
Practice Address - Phone:217-737-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health