Provider Demographics
NPI:1063189983
Name:BOYLE, KELLY MICHELLE (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PIONEER AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3300
Mailing Address - Country:US
Mailing Address - Phone:360-701-1019
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE E STE 420
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1189
Practice Address - Country:US
Practice Address - Phone:360-701-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60747904101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health