Provider Demographics
NPI:1740942309
Name:HENRY, KIERA
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:
Last Name:HENRY
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:PO BOX 65190
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-0004
Mailing Address - Country:US
Mailing Address - Phone:904-874-7571
Mailing Address - Fax:
Practice Address - Street 1:115 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-9035
Practice Address - Country:US
Practice Address - Phone:904-602-9802
Practice Address - Fax:904-621-5113
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLIMH27868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician