Provider Demographics
NPI:1245788694
Name:FROST, KELLY (MS, SUDP)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:MS, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5014
Mailing Address - Country:US
Mailing Address - Phone:360-676-4485
Mailing Address - Fax:360-714-1294
Practice Address - Street 1:1155 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5037
Practice Address - Country:US
Practice Address - Phone:360-676-4485
Practice Address - Fax:360-714-1294
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60545681101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)