Provider Demographics
NPI:1003601857
Name:HENRY, KIMBALY
Entity type:Individual
Prefix:
First Name:KIMBALY
Middle Name:
Last Name:HENRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 28TH AVE N STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4456
Mailing Address - Country:US
Mailing Address - Phone:615-208-2908
Mailing Address - Fax:615-534-2169
Practice Address - Street 1:500 28TH AVE N STE 210
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4456
Practice Address - Country:US
Practice Address - Phone:615-208-2908
Practice Address - Fax:615-534-2169
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional