Provider Demographics
NPI:1932942604
Name:HENDRICKSON, ROSS
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15727 PONDEROSA PASS
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3684
Mailing Address - Country:US
Mailing Address - Phone:210-776-3015
Mailing Address - Fax:
Practice Address - Street 1:15727 PONDEROSA PASS
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3684
Practice Address - Country:US
Practice Address - Phone:210-776-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health