Individual
TYLIE SHAE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
56-660 KAMEHAMEHA HWY, KAHUKU, HI 96731-2210
(801) 822-6716
Mailing address
1484 N 950 W, LEHI, UT 84043-1099
(801) 822-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/05/2021
Last updated
02/05/2021
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