Individual
JEFFERY HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
116 SE AVE N, IDABEL, OK 74745-5234
(580) 286-6671
(580) 286-5747
Mailing address
116 SE AVE N, IDABEL, OK 74745-5234
(580) 286-6671
(580) 286-5747
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/11/2010
Last updated
08/11/2010
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