Provider Demographics
NPI:1669837621
Name:GALLENTINE, KILEY K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KILEY
Middle Name:K
Last Name:GALLENTINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 WAYNE AVE SE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1453
Mailing Address - Country:US
Mailing Address - Phone:206-240-8396
Mailing Address - Fax:
Practice Address - Street 1:413 WAYNE AVE SE
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:WA
Practice Address - Zip Code:98047-1453
Practice Address - Country:US
Practice Address - Phone:206-240-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60619294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health