Healthcare Provider Details

I. General information

NPI: 1700488442
Provider Name (Legal Business Name): KIMBERLY HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 BARNES RD
COLORADO SPRINGS CO
80922-2600
US

IV. Provider business mailing address

2212 N CHELTON RD
COLORADO SPRINGS CO
80909-1410
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-0822
  • Fax:
Mailing address:
  • Phone: 719-209-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58593
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: