Provider Demographics
NPI:1760627269
Name:HENDERSEN, LUTHER J (CAC III)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:J
Last Name:HENDERSEN
Suffix:
Gender:M
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5698 S HWY 85
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1465
Mailing Address - Country:US
Mailing Address - Phone:719-390-4652
Mailing Address - Fax:719-227-2119
Practice Address - Street 1:5698 S HWY 85
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1465
Practice Address - Country:US
Practice Address - Phone:719-390-4652
Practice Address - Fax:719-227-2119
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4741101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)