Provider Demographics
NPI:1316639420
Name:HENDERSHOT, KERRY SEAN (LPC)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:SEAN
Last Name:HENDERSHOT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 N LAKES PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1833
Mailing Address - Country:US
Mailing Address - Phone:208-888-5905
Mailing Address - Fax:833-520-4889
Practice Address - Street 1:2995 N COLE RD STE 260
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5976
Practice Address - Country:US
Practice Address - Phone:208-888-5905
Practice Address - Fax:833-520-4889
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health