Provider Demographics
NPI:1992033211
Name:BARROS-HENDERSON, TINA M (BA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:BARROS-HENDERSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5093 ELDORA AVE
Mailing Address - Street 2:#2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5468
Mailing Address - Country:US
Mailing Address - Phone:415-235-2485
Mailing Address - Fax:
Practice Address - Street 1:5093 ELDORA AVE
Practice Address - Street 2:#2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5468
Practice Address - Country:US
Practice Address - Phone:415-235-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health