Provider Demographics
NPI:1750597621
Name:HENDERS, WILLIAM B (MA LLP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:HENDERS
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 FULTON ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8455
Mailing Address - Country:US
Mailing Address - Phone:616-443-3911
Mailing Address - Fax:
Practice Address - Street 1:4670 FULTON ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8455
Practice Address - Country:US
Practice Address - Phone:616-443-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012460103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling