Provider Demographics
NPI:1972106284
Name:HENDERSON, JOSHUA MASON (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MASON
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6308
Mailing Address - Country:US
Mailing Address - Phone:337-450-9474
Mailing Address - Fax:
Practice Address - Street 1:118 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2510
Practice Address - Country:US
Practice Address - Phone:337-242-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8478101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health