Provider Demographics
NPI:1275779662
Name:HEINLEN, KELLY J (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:HEINLEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:MORASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1010 N MORTON ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111
Mailing Address - Country:US
Mailing Address - Phone:509-844-8774
Mailing Address - Fax:
Practice Address - Street 1:1010 N MORTON ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111
Practice Address - Country:US
Practice Address - Phone:509-844-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60065038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health