Keith Jacob Hendrix, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C1799 Issued in OR

Practice address

45 NW Greeley Ave
Bend, OR 97703-2943

Phone

(503) 616-1236

Fax

(855) 305-5252

NPI assigned

Mar 6, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1861662751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53501 BROOKIE WAY",
            "city": "LA PINE",
            "state": "OR",
            "postal_code": "977399440",
            "telephone_number": "503-616-1236",
            "fax_number": "855-305-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 NW GREELEY AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977032943",
            "telephone_number": "503-616-1236",
            "fax_number": "855-305-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRIX",
        "first_name": "KEITH",
        "middle_name": "JACOB",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-06",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "C1799",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C1799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123190",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sylvia Dianne Henderson, LPC
• Tracy Renee Henderson
• Valerie Rose Henderson
• Abby P. Hendricks, M.D.
• Andrea Jeanne Hendrickson
• Annie N. Hendryx, MD
• Randi Hennigan, PHD, LMFT
• Ryan John Henrick
• James Alan Henson, LCSW
• Matthew Adam Henson

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; 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.