Provider Demographics
NPI:1255086013
Name:HENDERSON, TONYAKRISTIN
Entity type:Individual
Prefix:MS
First Name:TONYAKRISTIN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 S ERIE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-7264
Mailing Address - Country:US
Mailing Address - Phone:732-682-5881
Mailing Address - Fax:
Practice Address - Street 1:1810 S ERIE AVE APT 2
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-7264
Practice Address - Country:US
Practice Address - Phone:732-682-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst