Provider Demographics
NPI:1952448524
Name:HENDERSON, JAMES KEETON (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEETON
Last Name:HENDERSON
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 1:359 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4862
Mailing Address - Country:US
Mailing Address - Phone:601-572-8686
Mailing Address - Fax:601-572-8685
Practice Address - Street 1:359 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4862
Practice Address - Country:US
Practice Address - Phone:601-572-8686
Practice Address - Fax:601-572-8685
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional