Healthcare Provider Details

I. General information

NPI: 1952577934
Provider Name (Legal Business Name): KELLY J NIESS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 GUEMES VW
ANACORTES WA
98221-1118
US

IV. Provider business mailing address

325 E PIONEER AVE
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 206-999-6771
  • Fax:
Mailing address:
  • Phone: 253-697-8548
  • Fax: 253-697-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLF60123463
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: