Individual
KEONI K HENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1711 E BARNACLE AVE, APACHE JUNCTION, AZ 85119-3796
(775) 412-2351
Mailing address
588 CARSON PASS CT, SPARKS, NV 89436-1877
(775) 412-2351
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
AZ
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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