Provider Demographics
NPI:1588350011
Name:MCHENRY, KRYSSA JEALEN
Entity type:Individual
Prefix:
First Name:KRYSSA
Middle Name:JEALEN
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TADMORE CT APT 203
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-8628
Mailing Address - Country:US
Mailing Address - Phone:443-255-9534
Mailing Address - Fax:
Practice Address - Street 1:179 ADMIRAL COCHRANE DR STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7633
Practice Address - Country:US
Practice Address - Phone:410-573-9300
Practice Address - Fax:410-573-9305
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician