Active NPI
Kimberly J Henderson, MA, LMHC
- Mental Health Counselor
- Olympia, WA
National Provider Identifier
1619085222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LH00009495
- Practice address
- 222 Kenyon St NW
Suite 10
Olympia, WA 98502-4553 - Phone
- (360) 704-8298
- Fax
- (360) 866-0770
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH00009495 | WA | Primary |
Addresses
Primary practice location
222 Kenyon St NW
Suite 10
Olympia, WA 98502-4553
Mailing address
1322 Mirada Dr NW
Olympia, WA 98502-4099
Phone (360) 704-8298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1981125 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 26, 2024 through Aug 26, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH00009495 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619085222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 MIRADA DR NW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985024099",
"telephone_number": "360-704-8298",
"fax_number": "360-866-0770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 KENYON ST NW",
"address_2": "SUITE 10",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985024553",
"telephone_number": "360-704-8298",
"fax_number": "360-866-0770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KIMBERLY",
"middle_name": "J",
"credential": "MA, LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH00009495",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1981125",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.