Provider Demographics
NPI:1114774718
Name:HENDERSON, ANN L (RBT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:L
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:15262 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76534-5182
Mailing Address - Country:US
Mailing Address - Phone:254-598-0051
Mailing Address - Fax:
Practice Address - Street 1:213 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-5537
Practice Address - Country:US
Practice Address - Phone:254-308-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-25640106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician