Provider Demographics
NPI:1326426982
Name:HENDERSON, KELLI (MS LMFT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 E YALE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6930
Mailing Address - Country:US
Mailing Address - Phone:303-921-2771
Mailing Address - Fax:
Practice Address - Street 1:5500 E YALE AVE STE 202
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6930
Practice Address - Country:US
Practice Address - Phone:303-921-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO880101YA0400X
CO1231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)