Provider Demographics
NPI:1336201656
Name:KELLY, ANGELA F (LMHC GMHS)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:F
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMHC GMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 GREENWOOD AVE N
Mailing Address - Street 2:707
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3614
Mailing Address - Country:US
Mailing Address - Phone:425-269-2954
Mailing Address - Fax:
Practice Address - Street 1:6523 21ST AVE NE
Practice Address - Street 2:5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6924
Practice Address - Country:US
Practice Address - Phone:425-269-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00052817101YP2500X
WALH00011244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional