| Doctor Name: | MRS. TRACI NICOLE LAMERE HENDERSON |
| NPI Number: | 1891994000 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAC |
| License Number: | 1209 |
| Business Practice Address: | Rr 1 Box 664 Box Elder, MT - 595219797 |
| Business Phone Number: | 4063954818 |
| Business Fax Number: | 4063954861 |
| Mailing Address: | Rr 1 Box 664, BOX ELDER |
| State: | MT |
| Postal Code: | 595219797 |
| Phone Number: | 4063954818 |
| Fax Number: | 4063954861 |
| NPI Enumeration Date: | 07/17/2007 |
| NPI Last Update Date: | 07/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1209 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |