Healthcare Provider Details

I. General information

NPI: 1396281903
Provider Name (Legal Business Name): KYLIE CHAFFIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 N NEVADA ST STE 103
SPOKANE WA
99218-1145
US

IV. Provider business mailing address

9921 N NEVADA ST STE 103
SPOKANE WA
99218-1145
US

V. Phone/Fax

Practice location:
  • Phone: 509-581-2690
  • Fax: 509-593-4676
Mailing address:
  • Phone: 509-581-2690
  • Fax: 509-593-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015103
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60799157
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMC60669894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: