MEDICARE: MRS. KRYSTIN KAREE HENLEY M.S., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1417	NC

General Provider Information

NPI Number	:	1710251491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTIN KAREE HENLEY M.S., LMFT

Provider Business Mailing Address
First Line	:	533 IVY GLEN DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-4062
Country	:	US
Telephone Number	:	423-991-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 IVY GLEN DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-4062
Country	:	US
Telephone Number	:	423-991-9311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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