Provider Demographics
NPI:1538852058
Name:KEVALA COUNSELING, LLC
Entity type:Organization
Organization Name:KEVALA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-480-0027
Mailing Address - Street 1:4570 AVERY LN SE STE C102
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5608
Mailing Address - Country:US
Mailing Address - Phone:360-480-0027
Mailing Address - Fax:
Practice Address - Street 1:8613 MARTIN WAY E STE 201
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5820
Practice Address - Country:US
Practice Address - Phone:360-480-0027
Practice Address - Fax:360-634-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty