Provider Demographics
NPI:1861594095
Name:HENDERSON, JENNIFER BETH (MA LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 RENTON AVE S # B106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1980
Mailing Address - Country:US
Mailing Address - Phone:206-384-5229
Mailing Address - Fax:
Practice Address - Street 1:5036 RENTON AVE S # B106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1980
Practice Address - Country:US
Practice Address - Phone:206-384-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60200458101YM0800X
IL221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist