Provider Demographics
NPI:1922493154
Name:HENSON, PAUL CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:HENSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GUYS
Mailing Address - State:TN
Mailing Address - Zip Code:38339-5133
Mailing Address - Country:US
Mailing Address - Phone:731-646-0734
Mailing Address - Fax:
Practice Address - Street 1:584 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2310
Practice Address - Country:US
Practice Address - Phone:731-646-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3378101YM0800X, 101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534472Medicaid
TN13528875OtherCAQH