Individual
MICHAEL JAMES HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW LICENSED CLINIC
Contact information
Practice address
433 MAIN, SUITE 4B, KALISPELL, MT 59901
(406) 756-0794
Mailing address
212 LAKESHORE DRIVE, KALISPELL, MT 59901
(406) 756-0794
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
320LCSW
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0501432
—
MT
01
—
0704115
BLUE CROSS BLUE SHIELD
MT
01
—
P00295420
MEDICARE RAILROAD
—
Enumeration date
08/20/2006
Last updated
07/08/2007
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