Healthcare Provider Details

I. General information

NPI: 1629219167
Provider Name (Legal Business Name): KELLY KERBY LMHC, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NE 95TH ST
SEATTLE WA
98115-2426
US

IV. Provider business mailing address

2400 NE 95TH ST
SEATTLE WA
98115-2426
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5050
  • Fax: 206-525-9795
Mailing address:
  • Phone: 206-525-5050
  • Fax: 206-525-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00006207
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: