Individual
THOMAS HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, HSPP, LMFT
Contact information
Practice address
221 E WESLEY DR, BRAZIL, IN 47834-6826
(812) 448-1151
(812) 446-5302
Mailing address
221 E WESLEY DR, BRAZIL, IN 47834-6826
(812) 448-1151
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20090131
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079240
—
IN
Enumeration date
05/05/2006
Last updated
04/19/2011
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