Provider Demographics
NPI:1447610274
Name:EBELS, KELLY (LMHCA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:EBELS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 20TH STREET CT W
Mailing Address - Street 2:SUITE B
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6212
Mailing Address - Country:US
Mailing Address - Phone:253-642-7419
Mailing Address - Fax:
Practice Address - Street 1:6512 20TH STREET CT W
Practice Address - Street 2:SUITE B
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6212
Practice Address - Country:US
Practice Address - Phone:253-642-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health