Provider Demographics
NPI:1528040730
Name:HENDERSON, SYLVIA DIANNE (LPC)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:DIANNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67170 HARRINGTON LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-389-6360
Mailing Address - Fax:541-389-6360
Practice Address - Street 1:500 SW BOND SUITE 106
Practice Address - Street 2:SUITE 106
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-389-6360
Practice Address - Fax:541-389-6360
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO716101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health