Provider Demographics
NPI:1255413118
Name:JEFF HENDERSON PHD PSYCHOLOGICAL SERVICES AND CONSULTING PC
Entity type:Organization
Organization Name:JEFF HENDERSON PHD PSYCHOLOGICAL SERVICES AND CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:928-458-6634
Mailing Address - Street 1:7929 E SLEEPY OWL WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-3023
Mailing Address - Country:US
Mailing Address - Phone:928-458-6634
Mailing Address - Fax:
Practice Address - Street 1:1680 W IRON SPRINGS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3313
Practice Address - Country:US
Practice Address - Phone:928-458-6634
Practice Address - Fax:928-445-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4041103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty