Provider Demographics
NPI:1427864305
Name:O'NEILL, KELSEY ALYSE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALYSE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NW 73RD CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8467
Mailing Address - Country:US
Mailing Address - Phone:360-606-6305
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD STE 311B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5091
Practice Address - Country:US
Practice Address - Phone:360-606-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health