Basic Information
| Provider Information | |||||||||
| NPI: | 1174937742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDRICK | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3570 COUNTY ROAD 345 | ||||||||
| Address2: | |||||||||
| City: | BRAZORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774227222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9792369545 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 W ADOUE ST | ||||||||
| Address2: | |||||||||
| City: | ALVIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775112718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 8774892319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 69057 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.