Provider Demographics
NPI:1184899809
Name:HENLEY PRICE, KRISTIN (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HENLEY PRICE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18230 E SILVER CREEK AVE BLDG 392
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9501
Mailing Address - Country:US
Mailing Address - Phone:720-847-6451
Mailing Address - Fax:
Practice Address - Street 1:18230 EAST SILVER CREEK STREET
Practice Address - Street 2:BLDG 392, MDG SOUTH
Practice Address - City:BUCKLEY SFB
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:720-847-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003183103T00000X
COPSY.0003722103TC0700X
COPSY-3722103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184899809OtherMILITARY