Provider Demographics
NPI:1386345759
Name:BILLINGS, KELLY LYNN (CBT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 SE KELBY CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5556
Mailing Address - Country:US
Mailing Address - Phone:701-500-0944
Mailing Address - Fax:
Practice Address - Street 1:2327 SE KELBY CIR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5556
Practice Address - Country:US
Practice Address - Phone:170-150-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61148327106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician