Basic Information
| Provider Information | |||||||||
| NPI: | 1265041115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | TAMATHY | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1689 GREENSBURG RD | ||||||||
| Address2: | |||||||||
| City: | HODGENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427489724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027790354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 129B HOWELL DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702346139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 260844 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.