Active NPI
Farrell Lamont Henderson III
- Behavior Technician
- Bloomington, IN
National Provider Identifier
1124918586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 239 E Winslow Rd
Bloomington, IN 47401-8638 - Phone
- (812) 202-6001
- NPI assigned
- Jul 8, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
239 E Winslow Rd
Bloomington, IN 47401-8638
Mailing address
239 E Winslow Rd
Bloomington, IN 47401-8638
Phone (812) 202-6001
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rise Autism LLC | Behavior Technician | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751932800000",
"number": "1124918586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 E WINSLOW RD",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474018638",
"telephone_number": "812-202-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "239 E WINSLOW RD",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474018638",
"telephone_number": "812-202-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "FARRELL",
"middle_name": "LAMONT",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-08",
"last_updated": "2025-07-08",
"certification_date": "2025-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.