Provider Demographics
NPI:1083940043
Name:MCDONALD, KELLY MARIE (BA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:STINNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4414
Mailing Address - Country:US
Mailing Address - Phone:360-676-7530
Mailing Address - Fax:360-676-6001
Practice Address - Street 1:609 N SHORE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4414
Practice Address - Country:US
Practice Address - Phone:360-676-7530
Practice Address - Fax:360-676-6001
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor