Provider Demographics
NPI:1588786362
Name:HENDERSON, KATHARINE J (BA)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 ESTACIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2213
Mailing Address - Country:US
Mailing Address - Phone:949-363-0441
Mailing Address - Fax:
Practice Address - Street 1:1901 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3457
Practice Address - Country:US
Practice Address - Phone:714-780-0750
Practice Address - Fax:714-780-0757
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health