Doctor Name: | CLIFTON KELLY |
NPI Number: | 1063830289 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | LH60468765 |
Business Practice Address: | 15408 Main St #107 Mill Creek, WA - 980129024 |
Business Phone Number: | 2062953784 |
Business Fax Number: | |
Mailing Address: | 15408 Main St, #107 MILL CREEK |
State: | WA |
Postal Code: | 980129024 |
Phone Number: | 2062953784 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2014 |
NPI Last Update Date: | 05/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60468765 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |