Provider Demographics
NPI:1023791415
Name:HENDERSON, KRYSTAL LYNN (CCMA, CPHT, QMHA-R)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CCMA, CPHT, QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2723
Mailing Address - Country:US
Mailing Address - Phone:541-883-2795
Mailing Address - Fax:541-883-8194
Practice Address - Street 1:2555 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2723
Practice Address - Country:US
Practice Address - Phone:541-883-2795
Practice Address - Fax:541-883-8194
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health