Individual provider Active NPI

John Marshall Henderson III

  • Behavior Technician
  • Elk Grove, CA
National Provider Identifier
1972410728
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
9355 East Stockton Boulaevard Ste 100
Elk Grove, CA 95624
Phone
(916) 683-1109
NPI assigned
Aug 26, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

9355 East Stockton Boulaevard Ste 100
Elk Grove, CA 95624

Mailing address

300 International Pkwy Ste 200
Lake Mary, FL 32746-5028
Phone (866) 610-0580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1787702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1972410728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 INTERNATIONAL PKWY STE 200",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465028",
            "telephone_number": "866-610-0580",
            "fax_number": "866-611-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9355 EAST STOCKTON BOULAEVARD STE 100",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "95624",
            "telephone_number": "916-683-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JOHN",
        "middle_name": "MARSHALL",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-08-26",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.