Healthcare Provider Details

I. General information

NPI: 1760252076
Provider Name (Legal Business Name): ANDROMEDA LITTRELL KELLEMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDI LITTRELL

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SW 320TH ST
FEDERAL WAY WA
98023-2292
US

IV. Provider business mailing address

28115 10TH AVE S
DES MOINES WA
98198-8211
US

V. Phone/Fax

Practice location:
  • Phone: 253-289-6099
  • Fax:
Mailing address:
  • Phone: 360-460-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61642697
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: