Individual
BLAKE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA, M. ED.
Contact information
Practice address
12604 HIDDENCREEK WAY STE C, CERRITOS, CA 90703-2137
(562) 261-9101
Mailing address
PO BOX 740780, ATLANTA, GA 30374-0780
(855) 223-7123
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-29346
CA
Other
Enumeration date
03/23/2018
Last updated
04/22/2026
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