1255413118 NPI number — JEFF HENDERSON PHD PSYCHOLOGICAL SERVICES AND CONSULTING PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255413118 NPI number — JEFF HENDERSON PHD PSYCHOLOGICAL SERVICES AND CONSULTING PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFF HENDERSON PHD PSYCHOLOGICAL SERVICES AND CONSULTING PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255413118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7929 E SLEEPY OWL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86315-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-458-6634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 W IRON SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-458-6634
Provider Business Practice Location Address Fax Number:
928-445-2919
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT PSYCHOLOGIST
Authorized Official Telephone Number:
928-458-6634

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  4041 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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