Provider Demographics
NPI:1083112817
Name:SAMLI, KELLY LYNN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:SAMLI
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 95TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5153
Mailing Address - Country:US
Mailing Address - Phone:425-463-9062
Mailing Address - Fax:
Practice Address - Street 1:22232 17TH AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7425
Practice Address - Country:US
Practice Address - Phone:425-487-1005
Practice Address - Fax:425-487-4884
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health