Provider Demographics
NPI:1548391816
Name:HENRY, KRISTEN D (MA LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:D
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:726 BLUEBIRD LANE
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160
Mailing Address - Country:US
Mailing Address - Phone:734-323-1857
Mailing Address - Fax:
Practice Address - Street 1:216 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2786
Practice Address - Country:US
Practice Address - Phone:734-323-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006409101YP2500X
MIL2002448101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional