Provider Demographics
NPI:1881564805
Name:HENDERSON, BREKIN
Entity type:Individual
Prefix:
First Name:BREKIN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREKIN
Other - Middle Name:
Other - Last Name:SHUFFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202 COUNTY ROAD 4032
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76632-3053
Mailing Address - Country:US
Mailing Address - Phone:254-265-0704
Mailing Address - Fax:
Practice Address - Street 1:202 COUNTY ROAD 4032
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:TX
Practice Address - Zip Code:76632-3053
Practice Address - Country:US
Practice Address - Phone:254-265-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-05
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician