Provider Demographics
NPI:1710784517
Name:HENDRA, PHILLIP D (LMHC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:D
Last Name:HENDRA
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 AGUILA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1467
Mailing Address - Country:US
Mailing Address - Phone:239-209-1994
Mailing Address - Fax:
Practice Address - Street 1:2033 WOOD ST STE 120
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7933
Practice Address - Country:US
Practice Address - Phone:941-928-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health