Provider Demographics
NPI:1528115284
Name:HENDERS, MARYPAT (LCPC)
Entity type:Individual
Prefix:
First Name:MARYPAT
Middle Name:
Last Name:HENDERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31480 N US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9444
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:
Practice Address - Street 1:31480 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9444
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health