Henderson, Crystal
Henderson, Crystal is an sole proprietor health care provider with primary practice located at 401 E 162Nd St Ste 103 , South Holland IL 60473-2237. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Henderson, Crystal can be contacted via phone (773) 819-5504.Contact Information
Primary practice address
401 E 162Nd St Ste 103
South Holland IL 60473-2237
Phone: (773) 819-5504
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | Illinois |
Profile Details
| NPI number | 1124519806 |
|---|---|
| LBN Legal business name | Henderson, Crystal |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 29th, 2018 |
| Last updated | May 29th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124519806 | NPPES |
| Illinois | MEDICAID | 101YM0800X |
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