Provider Demographics
NPI:1215145743
Name:HENDERSON, RUTH ELAINE (FELLOW, AAPC)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELAINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FELLOW, AAPC
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ELAINE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV
Mailing Address - Street 1:6512 ROBAR TESORA ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8933
Mailing Address - Country:US
Mailing Address - Phone:330-701-4659
Mailing Address - Fax:
Practice Address - Street 1:6512 ROBAR TESORA ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8933
Practice Address - Country:US
Practice Address - Phone:330-701-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral