Provider Demographics
NPI:1770940181
Name:HENDRY, KRIS MICHELLE
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:MICHELLE
Last Name:HENDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTOFER
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:842 CABALLO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4539
Mailing Address - Country:US
Mailing Address - Phone:909-544-3464
Mailing Address - Fax:
Practice Address - Street 1:14240 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1940
Practice Address - Country:US
Practice Address - Phone:562-946-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst