Provider Demographics
NPI:1063774354
Name:MBOSOWO, HENSHAW D (LPC)
Entity type:Individual
Prefix:
First Name:HENSHAW
Middle Name:D
Last Name:MBOSOWO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 HOBART CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3455
Mailing Address - Country:US
Mailing Address - Phone:469-733-2007
Mailing Address - Fax:469-617-7052
Practice Address - Street 1:3128 HUDSON XING STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6556
Practice Address - Country:US
Practice Address - Phone:469-252-7090
Practice Address - Fax:469-617-7052
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
TX71354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral