Provider Demographics
NPI:1497111660
Name:HENRY-NANCE, KIM (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:HENRY-NANCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S EUCLID AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2471
Mailing Address - Country:US
Mailing Address - Phone:626-708-0774
Mailing Address - Fax:626-395-7401
Practice Address - Street 1:130 S EUCLID AVE
Practice Address - Street 2:STE 4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2471
Practice Address - Country:US
Practice Address - Phone:626-708-0774
Practice Address - Fax:626-395-7401
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist