Doctor Name: | LAURA HENDERSHOTT |
NPI Number: | 1093138125 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN BSN |
License Number: | RN710436 |
Business Practice Address: | 829 Halbert St Malvern, AR - 721042607 |
Business Phone Number: | 8705573238 |
Business Fax Number: | |
Mailing Address: | 829 Halbert St, MALVERN |
State: | AR |
Postal Code: | 721042607 |
Phone Number: | 8705573238 |
Fax Number: | |
NPI Enumeration Date: | 01/24/2014 |
NPI Last Update Date: | 01/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | RN710436 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |