Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 3167-57 | WI |
Y | 103TC0700X | Clinical Psychologist | 3167-57 | WI |
N | 103TP2701X | Group Psychotherapist |
NPI | 1073899340 |
---|---|
Provider Name | Valerie Henderson |
First Address | Monona, WI 53713-4835 |
Second Address | Monona, WI 53713-4835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 21/01/2016 |