Provider Demographics
NPI:1174484752
Name:DELAY, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DELAY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SE 32ND AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1971
Mailing Address - Country:US
Mailing Address - Phone:503-929-9413
Mailing Address - Fax:503-929-9413
Practice Address - Street 1:236 SE 32ND AVE APT 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1971
Practice Address - Country:US
Practice Address - Phone:503-929-9413
Practice Address - Fax:503-929-9413
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty