Latundra Henderson, LISW, LICDC is a medicare enrolled "Social Worker - Clinical" provider in Mentor, Ohio. Her current practice location is
7232 Justin Way, Mentor, Ohio. You can reach out to her office (for appointments etc.) via phone at
(440) 578-8200.
Latundra Henderson is licensed to practice in Ohio (license number I.2002418-SUPV) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1326599663.
Healthcare Provider's Profile
| Full Name | Latundra Henderson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 7232 Justin Way, Mentor, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1326599663
- Provider Enumeration Date: 10/21/2016
- Last Update Date: 01/28/2022
Medicare PECOS Information:
- PECOS PAC ID: 0143632893
- Enrollment ID: I20201222001003
Medical Identifiers
Medical identifiers for Latundra Henderson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1326599663 | NPI | - | NPPES |
| 0423502 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LICDC161330 (Ohio) | Secondary |
| 106H00000X | Marriage & Family Therapist | S1600147 (Ohio) | Secondary |
| 1041C0700X | Social Worker - Clinical | I.2002418-SUPV (Ohio) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Latundra Henderson allows following entities to bill medicare on her behalf.
| Entity Name | Signature Health, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1679767289
PECOS PAC ID: 8628970985
Enrollment ID: O20040126000762 |
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| Entity Name | Your Precious Dreams Llc Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770282220
PECOS PAC ID: 0446771141
Enrollment ID: O20250311001514 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Latundra Henderson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Latundra Henderson, LISW, LICDC
7232 Justin Way,
Mentor, OH 44060-4881
Ph: (440) 578-8200 | Latundra Henderson, LISW, LICDC
7232 Justin Way,
Mentor, OH 44060-4881
Ph: (440) 578-8200 |
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