Provider Demographics
NPI:1891947339
Name:HENDRIX, JAMES LEE (MA:MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MA:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HAHN DR APT A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0665
Mailing Address - Country:US
Mailing Address - Phone:925-209-8133
Mailing Address - Fax:
Practice Address - Street 1:2937 VENEMAN AVE
Practice Address - Street 2:SUITE B250/B255
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0638
Practice Address - Country:US
Practice Address - Phone:925-209-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist