Davetta A Henderson, PSYD, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

91192 Issued in TX

Practice address

4115 E Lancaster Ave
Fort Worth, TX 76103-3614

Phone

(817) 796-7370

NPI assigned

Dec 2, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Davetta A Carlisle Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Talkspace Provider Network PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York, NY
  • NPI 1639814049

  TX

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1164069829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N MERIDIAN ST STE 505",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021433",
            "telephone_number": "317-464-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 E LANCASTER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761033614",
            "telephone_number": "817-796-7370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 N Meridian St Ste 505",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021433",
            "country_code": "US",
            "telephone_number": "317-464-3515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DAVETTA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PSYD, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003653A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "91192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVETTA",
            "last_name": "CARLISLE",
            "middle_name": "A",
            "prefix": "DR.",
            "credential": "CARLISLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Henderson Interventional Pain Center, LLC
• Henderson Optical
• Henderson Optical, LLC
• Yolanda Denise Henderson-Chambers, RN
• Candance Henderson
• Duane Melvin Henderson
• Janet L Henderson, MD
• Lavorya B Henderson, PHLEBOTOMIST
• Rhonda Ann Henderson, FNP
• Rhonda Sue Henderson, L.P.T.

• Mental Health Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.