Individual
MRS. CRYSTAL HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 E 162ND ST STE 103, SOUTH HOLLAND, IL 60473-2237
(773) 819-5504
Mailing address
401 E 162ND ST STE 103, SOUTH HOLLAND, IL 60473-2237
(773) 819-5504
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
IL
Enumeration date
05/29/2018
Last updated
05/29/2018
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