Healthcare Provider Details

I. General information

NPI: 1669151999
Provider Name (Legal Business Name): KELLEY MCCARVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 COLUMBIA RD
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

337 NE THORNTON PL APT 2-433
SEATTLE WA
98125-8036
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-5153
  • Fax:
Mailing address:
  • Phone: 720-998-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70172065
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: