Provider Demographics
NPI:1770816035
Name:HENDERSON, EASON (MC)
Entity Type:Individual
Prefix:
First Name:EASON
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4046
Mailing Address - Country:US
Mailing Address - Phone:425-388-7215
Mailing Address - Fax:425-388-7216
Practice Address - Street 1:3000 ROCKEFELLER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4046
Practice Address - Country:US
Practice Address - Phone:425-388-7215
Practice Address - Fax:425-388-7216
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00004040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional