Active NPI
Dennis W Henderson, PSY.D.
- Clinical Psychologist
- Gladstone, OR
National Provider Identifier
1699839753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1079
- Practice address
- 880 82ND Dr
Gladstone, OR 97027-1803 - Phone
- (503) 659-5515
- Fax
- (503) 659-1994
- NPI assigned
- Dec 21, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1079 | OR | Primary |
Addresses
Primary practice location
880 82ND Dr
Gladstone, OR 97027-1803
Mailing address
PO Box 82819
Portland, OR 97282-0819
Phone (503) 233-5405
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164936 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1079 | OR | MD | Naturopath |
Interoperability endpoints
- lifestancehealth.dennishenderson@148835.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1699839753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 82819",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972820819",
"telephone_number": "503-233-5405",
"fax_number": "503-233-2696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 82ND DR",
"city": "GLADSTONE",
"state": "OR",
"postal_code": "970271803",
"telephone_number": "503-659-5515",
"fax_number": "503-659-1994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "DENNIS",
"middle_name": "W",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1079",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164936",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gladstone, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.