Provider Demographics
NPI:1962088203
Name:HENDERSON, TRICIA (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7352 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3545
Mailing Address - Country:US
Mailing Address - Phone:423-605-4758
Mailing Address - Fax:
Practice Address - Street 1:7352 BLACKSTONE DR
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3545
Practice Address - Country:US
Practice Address - Phone:423-605-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3078OtherSTATE OF TENNESSEE