Provider Demographics
NPI:1104620087
Name:HENKENER, KELLY (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HENKENER
Suffix:
Gender:
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROB ROY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3121
Mailing Address - Country:US
Mailing Address - Phone:512-653-5848
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR STE 32
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:512-653-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health