Active NPI
Harold Jordan Henderson, LPC
- Mental Health Counselor
- Wasilla, AK
National Provider Identifier
1083761241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 122
- Practice address
- 1075 Check St
Suite 101
Wasilla, AK 99654-8047 - Phone
- (907) 357-1629
- Fax
- (907) 357-1639
- NPI assigned
- Jan 3, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 122 | AK | Primary |
Addresses
Primary practice location
1075 Check St
Suite 101
Wasilla, AK 99654-8047
Mailing address
1075 Check St
Suite 101
Wasilla, AK 99654-8047
Phone (907) 357-1629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122 | AK | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harvest Counseling Center, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083761241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1075 CHECK ST",
"address_2": "SUITE 101",
"city": "WASILLA",
"state": "AK",
"postal_code": "996548047",
"telephone_number": "907-357-1629",
"fax_number": "907-357-1639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1075 CHECK ST",
"address_2": "SUITE 101",
"city": "WASILLA",
"state": "AK",
"postal_code": "996548047",
"telephone_number": "907-357-1629",
"fax_number": "907-357-1639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "HAROLD",
"middle_name": "JORDAN",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AK",
"license": "122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.