Provider Demographics
NPI:1912386905
Name:HENDERSON, SHIRLEY KATHRYN (LICENSED COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KATHRYN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LICENSED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 BOX J DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-7348
Mailing Address - Country:US
Mailing Address - Phone:928-530-6778
Mailing Address - Fax:
Practice Address - Street 1:2830 E GORDON DR
Practice Address - Street 2:COVENANT COUNSELING
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2736
Practice Address - Country:US
Practice Address - Phone:928-530-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral