Carly Marie Henderson, M.A., LPC, LMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C3645 Issued in OR

Practice address

3407 S Corbett Ave
Portland, OR 97239-4621

Phone

(971) 270-0658

Fax

(971) 244-7268

NPI assigned

May 13, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1194017764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 SE 12TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142513",
            "telephone_number": "971-270-0658",
            "fax_number": "971-244-7268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3407 S CORBETT AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394621",
            "telephone_number": "971-270-0658",
            "fax_number": "971-244-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "CARLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "M.A., LPC, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-13",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C3645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allen Maxwell Henderson
• April Nicole Henderson
• Austin C Henderson, RD
• Beau Henderson
• Bill N Henderson, DC
• Carmen Henderson, PA-C
• Charles A Henderson, RN
• Donna Mylinda Henderson
• Ian Henderson
• Jacob Henderson, MD

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.