Provider Demographics
NPI:1942307277
Name:HENDERSON, FELICIA M (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765023
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-5023
Mailing Address - Country:US
Mailing Address - Phone:972-224-1616
Mailing Address - Fax:
Practice Address - Street 1:12959 JUPITER RD STE 254
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5250
Practice Address - Country:US
Practice Address - Phone:214-221-0132
Practice Address - Fax:214-221-0242
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH1445101YM0800X
TX63920101YP2500X
CA47495106H00000X
TX201553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional