Healthcare Provider Details

I. General information

NPI: 1538852058
Provider Name (Legal Business Name): KEVALA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 MARTIN WAY E STE 201
LACEY WA
98516-5820
US

IV. Provider business mailing address

4570 AVERY LN SE STE C102
LACEY WA
98503-5608
US

V. Phone/Fax

Practice location:
  • Phone: 360-480-0027
  • Fax: 360-634-3590
Mailing address:
  • Phone: 360-480-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT CHARLES KELLER
Title or Position: OWNER
Credential: MA
Phone: 360-480-0027