Individual
LISA HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
35 SKYLINE DR, BRIGHAM CITY, UT 84302-6772
(801) 255-5131
Mailing address
6013 S REDWOOD RD, TAYLORSVILLE, UT 84123-5220
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
8479511-6006
UT
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104119619
MENTAL HEALTH INTERN
—
Enumeration date
10/19/2015
Last updated
05/18/2023
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