Provider Demographics
NPI:1346597366
Name:DEVOILLE, KELSEY (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DEVOILLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 127TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8741
Mailing Address - Country:US
Mailing Address - Phone:206-947-2733
Mailing Address - Fax:
Practice Address - Street 1:5740 127TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8741
Practice Address - Country:US
Practice Address - Phone:206-947-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60284752106H00000X
WALF60416904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist