Provider Demographics
NPI:1700292638
Name:HENDERSON, TRACY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6545
Mailing Address - Country:US
Mailing Address - Phone:206-228-5753
Mailing Address - Fax:
Practice Address - Street 1:1836 WESTLAKE AVE N STE 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2779
Practice Address - Country:US
Practice Address - Phone:206-228-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60980971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health