Provider Demographics
NPI:1891028783
Name:HENDREN, CAMILLA C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:C
Last Name:HENDREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:C
Other - Last Name:HENDREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-232-4417
Mailing Address - Fax:816-671-0961
Practice Address - Street 1:2303 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4954
Practice Address - Country:US
Practice Address - Phone:816-232-4417
Practice Address - Fax:816-671-0961
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6846104100000X
MO20090168961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200635210AMedicaid
MO1891028783Medicaid