Provider Demographics
NPI:1528450921
Name:HENDERSON, DEBRA (LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
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 1:105 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-9377
Mailing Address - Country:US
Mailing Address - Phone:903-747-7040
Mailing Address - Fax:903-978-2220
Practice Address - Street 1:7524 S BROADWAY AVE STE 105
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5000
Practice Address - Country:US
Practice Address - Phone:903-747-7040
Practice Address - Fax:903-978-2220
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional