Phyllis Jo Henderson, MD

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

26126 Issued in WA

Practice address

402 S 4TH Ave
Yakima, WA 98902-3546

Phone

(808) 575-4084

Fax

(509) 575-4234

NPI assigned

May 21, 2007

Last updated

Jan 4, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Loma Linda University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Comprehensive HealthcareGroup PAC ID 7618875022, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comprehensive Healthcare

  • Community/Behavioral Health Agency
  • Yakima, WA
  • NPI 1073527453
  Medicare reassignment Care Compare group NPD
• Westside Counseling Center

  • Addiction (Substance Use Disorder) Counselor
  • Yakima, WA
  • NPI 1174797302
  NPD (past) Authorized official
• Comprehensive Healthcare

  • Methadone Clinic
  • Yakima, WA
  • NPI 1588871693
  NPD

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1487863999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20980 STATE ROUTE 410",
            "city": "NACHES",
            "state": "WA",
            "postal_code": "989379173",
            "telephone_number": "509-658-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S 4TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023546",
            "telephone_number": "808-575-4084",
            "fax_number": "509-575-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "PHYLLIS",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "WA",
            "license": "26126",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "WA26126",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan R Hemstad, MD
• Jillian Henderson, LCSW, LAC
• John M Henderson, M.D.
• Kristy L Henderson
• Marjorie L Henderson, MD
• Sarah Anne Hendricks
• Sarah Hendrickson
• Tamela Marie Henne, L.M.P.
• Valerie Hennessy, ARNP
• Autumn Rose Henry, PHARMD

• Addiction Medicine (Psychiatry & Neurology) Physician in Yakima, WA
• Providers in Yakima, WA by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.