Provider Demographics
NPI:1700439775
Name:HENDERSON, HANNAH (BA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name: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 1:26967 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4360
Mailing Address - Country:US
Mailing Address - Phone:909-748-7141
Mailing Address - Fax:
Practice Address - Street 1:26967 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4360
Practice Address - Country:US
Practice Address - Phone:909-748-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor