Provider Demographics
NPI:1205478005
Name:HENDERSON, MEGAN (LPCC, LPATA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPCC, LPATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4849
Mailing Address - Country:US
Mailing Address - Phone:812-987-7272
Mailing Address - Fax:
Practice Address - Street 1:120 SEARS AVE STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5072
Practice Address - Country:US
Practice Address - Phone:502-414-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional