MEDICARE: KELSEY LAINE LAW MA, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MC60779213	WA
2	101YM0800X	Mental Health Counselor	LH61215981	WA

General Provider Information

NPI Number	:	1326550955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY LAINE LAW MA, LMHC

Provider Business Mailing Address
First Line	:	1900 NW DOCK PL STE 3
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 NW DOCK PL STE 3
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4846
Country	:	US
Telephone Number	:	206-486-0895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2017
Last Update Date	:	09/10/2021

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