Provider Demographics
NPI:1306399704
Name:HENRY, KAHDEJA (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:KAHDEJA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2634
Mailing Address - Country:US
Mailing Address - Phone:405-628-2812
Mailing Address - Fax:
Practice Address - Street 1:312 NE 28TH ST STE 109
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2822
Practice Address - Country:US
Practice Address - Phone:405-605-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool