Individual
LAWANDA L HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19925 E 44TH ST S, BROKEN ARROW, OK 74014-8224
(918) 951-3455
(918) 355-5734
Mailing address
19925 E 44TH ST S, BROKEN ARROW, OK 74014-8224
(918) 951-3455
(918) 355-5734
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20028712GA
—
OK
Enumeration date
03/25/2013
Last updated
11/27/2020
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