Provider Demographics
NPI:1194904458
Name:KELLEY, KATHERINE HELEN (M ED)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HELEN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 C ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1841
Mailing Address - Country:US
Mailing Address - Phone:509-760-2046
Mailing Address - Fax:
Practice Address - Street 1:21 C ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1841
Practice Address - Country:US
Practice Address - Phone:509-760-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health