Basic Information
Provider Information
NPI: 1518292317
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENDERSON
FirstName: LINDSAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA, LMFT
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 NEW SALEM RD
Address2: SUITE 116
City: UNIONTOWN
State: PA
PostalCode: 154018936
CountryCode: US
TelephoneNumber: 7244370729
FaxNumber: 7244372761
Practice Location
Address1: 100 NEW SALEM RD
Address2: SUITE 116
City: UNIONTOWN
State: PA
PostalCode: 154018936
CountryCode: US
TelephoneNumber: 7244370729
FaxNumber: 7244372761
Other Information
ProviderEnumerationDate: 10/12/2009
LastUpdateDate: 05/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMF000652PAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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