Provider Demographics
NPI:1609648203
Name:HEMPHILL, KELLY ANNE (LMHCA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANNE
Last Name:HEMPHILL
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 1:1919 QUEEN ANNE AVE N APT 412
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2561
Mailing Address - Country:US
Mailing Address - Phone:404-406-8342
Mailing Address - Fax:
Practice Address - Street 1:4501 15TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1874
Practice Address - Country:US
Practice Address - Phone:404-406-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61475758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health