Provider Demographics
NPI:1730388745
Name:HENJUM, LINDA LEE (MS)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:HENJUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:FARBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:719 WINDHAM SQ
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-2663
Mailing Address - Country:US
Mailing Address - Phone:402-943-8746
Mailing Address - Fax:
Practice Address - Street 1:719 WINDHAM SQ
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-2663
Practice Address - Country:US
Practice Address - Phone:402-943-8746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-2360101YM0800X
NE8317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional