ANNE A. HENDERSON, INC. — NPI 1205044294 (Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling in BROOKHAVEN, MS)

CMS-1500 Box 24J / 33a • NPI

1205044294

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TC1900X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling

Box 32 Service Location & ZIP+4

115 N CLEVELAND AVE, BROOKHAVEN, MS, 39601-2713

✓ 9-Digit EDI 837 ZIP+4 (39601-2713)

Practice Phone & Referral Fax

(601) 835-3306

Fax: (601) 835-3342

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205044294 (ANNE A. HENDERSON, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1205044294` (NPI-2 Organization / Facility)
Provider / Legal Name	ANNE A. HENDERSON, INC.
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling NUCC Code: `103TC1900X` (Psychologist, Counseling)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	115 N CLEVELAND AVE, BROOKHAVEN, MS, 39601-2713
Practice Telephone / Fax	Tel: (601) 835-3306 \| Fax: (601) 835-3342
Administrative Mailing Address	311 NATCHEZ AVE, BROOKHAVEN, MS, 39601-4055
Enumeration & Last Sync	Enumerated: 2007-05-21 \| CMS Record Updated: 2020-08-22
Authorized Official	ANNE HENDERSON (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

115 N CLEVELAND AVE, BROOKHAVEN, MS, 39601-2713

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Plain-English Taxonomy & CMS Crosswalk (103TC1900X)

What Does Taxonomy Code 103TC1900X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC1900X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Counseling for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANNE A. HENDERSON, INC.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: MS \| License: `30444` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ANNE A. HENDERSON, INC. (NPI #1205044294)