Provider Demographics
NPI:1972809028
Name:HENDERSON, JUSTIN D (PHD, LPC-S)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N SAM HOUSTON PKWY E # A165S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3305
Mailing Address - Country:US
Mailing Address - Phone:832-408-1368
Mailing Address - Fax:
Practice Address - Street 1:340 N SAM HOUSTON PKWY E # A165S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:832-408-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional