Provider Demographics
NPI:1730961343
Name:HENDERSON, KYLA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1827 N NATOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3919
Mailing Address - Country:US
Mailing Address - Phone:773-495-0695
Mailing Address - Fax:
Practice Address - Street 1:1608 5TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1302
Practice Address - Country:US
Practice Address - Phone:312-882-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-11021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical