Provider Demographics
NPI:1578851911
Name:KIMBEL, KELLY GALE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:GALE
Last Name:KIMBEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 SE LYNCH RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8644
Mailing Address - Country:US
Mailing Address - Phone:360-229-3987
Mailing Address - Fax:
Practice Address - Street 1:428 W BIRCH ST STE 11
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-1700
Practice Address - Country:US
Practice Address - Phone:360-229-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60206012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health