Healthcare Provider Details

I. General information

NPI: 1346574035
Provider Name (Legal Business Name): TIFFANY MARIE KELLY MS, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S ARTHUR ST STE 500
SPOKANE WA
99202-2260
US

IV. Provider business mailing address

140 S ARTHUR ST STE 500
SPOKANE WA
99202-2260
US

V. Phone/Fax

Practice location:
  • Phone: 509-744-1117
  • Fax: 509-744-3055
Mailing address:
  • Phone: 509-744-1117
  • Fax: 509-744-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60034712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: