Provider Demographics
NPI:1548500424
Name:HENDERSON, ELETHA LAJEWELL (MHPP)
Entity type:Individual
Prefix:MISS
First Name:ELETHA
Middle Name:LAJEWELL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:2126 N 1ST STREET
Practice Address - Street 2:SUITE F
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-5323
Practice Address - Country:US
Practice Address - Phone:501-982-5000
Practice Address - Fax:801-982-5007
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health