Provider Demographics
NPI:1770306078
Name:HENDERSON, ALYSSA MICHELLE (MA, LPC)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:MICHELLE
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2150 LAKESIDE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4467
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:972-669-8816
Practice Address - Street 1:2150 LAKESIDE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4467
Practice Address - Country:US
Practice Address - Phone:972-437-4698
Practice Address - Fax:972-669-8816
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional