Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY9334 | FL |
NPI | 1073976742 |
---|---|
Provider Name | Amberlee K. Henson |
First Address | Tavares, FL 32778-3249 |
Second Address | Tavares, FL 32778-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 11/07/2016 |