Provider Demographics
NPI:1649371212
Name:HENDRICKSEN, NORMAN E (PHD)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:E
Last Name:HENDRICKSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 27763
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-1031
Mailing Address - Country:US
Mailing Address - Phone:559-499-1233
Mailing Address - Fax:559-499-1232
Practice Address - Street 1:521 W. ENTERPRISE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8357
Practice Address - Country:US
Practice Address - Phone:559-322-9734
Practice Address - Fax:559-499-1232
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPL59380101Y00000X
CAPSY5938103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY059380Medicaid
CAOOPL59380Medicare ID - Type Unspecified
CAPSY059380Medicaid