Provider Demographics
NPI:1710918271
Name:DOLAN HENDERSON, ALVIN A (PHD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:A
Last Name:DOLAN HENDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3939
Mailing Address - Country:US
Mailing Address - Phone:512-219-8828
Mailing Address - Fax:512-219-8838
Practice Address - Street 1:11675 JOLLYVILLE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3939
Practice Address - Country:US
Practice Address - Phone:512-219-8828
Practice Address - Fax:512-219-8838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6316OtherBCBS
TX169870605Medicaid
TX8D6316OtherBCBS
TX8D6316Medicare ID - Type Unspecified