Provider Demographics
NPI:1841680634
Name:GIBBONS, KELLEE (MA, APPLYING LMHCA)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MA, APPLYING LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 STONECRESS LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2917
Mailing Address - Country:US
Mailing Address - Phone:206-300-7543
Mailing Address - Fax:
Practice Address - Street 1:1312 STONECRESS LN
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2917
Practice Address - Country:US
Practice Address - Phone:206-300-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health