Provider Demographics
NPI:1316078645
Name:HENSON, KELLY ROBB (MA, LLPC, NCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROBB
Last Name:HENSON
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2841
Mailing Address - Country:US
Mailing Address - Phone:248-545-0010
Mailing Address - Fax:
Practice Address - Street 1:15945 CANAL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1610
Practice Address - Country:US
Practice Address - Phone:586-416-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health