Provider Demographics
NPI:1114471877
Name:TEMPLER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TEMPLER
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 1:16715 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5310
Mailing Address - Country:US
Mailing Address - Phone:206-546-9766
Mailing Address - Fax:206-542-0326
Practice Address - Street 1:16715 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5310
Practice Address - Country:US
Practice Address - Phone:206-546-9766
Practice Address - Fax:206-542-0326
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2023-03-10
Deactivation Date:2021-09-16
Deactivation Code:
Reactivation Date:2023-03-10
Provider Licenses
StateLicense IDTaxonomies
MI6802089029104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker