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NPI Code Detail

MEDICARE: KIMBERLY E HENRY

MEDICARE: KIMBERLY E HENRY
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1801362322
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY E HENRY
Provider Business Mailing Address
First Line : PO BOX 1121
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-0254
Country : US
Telephone Number : 541-672-2691
Fax Number : 541-858-8167
Provider Business Practice Location Address
First Line : 3005 NE DIAMOND LAKE BLVD
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-3609
Country : US
Telephone Number : 541-673-3469
Fax Number : 541-266-0874
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2018
Last Update Date : 03/21/2024

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Directions to “ KIMBERLY E HENRY ” Practice Location

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