Provider Demographics
NPI:1699197285
Name:DEHAAN, KEILANI NICOLE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KEILANI
Middle Name:NICOLE
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KEILANI
Other - Middle Name:NICOLE
Other - Last Name:KOUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6710
Mailing Address - Country:US
Mailing Address - Phone:509-619-5725
Mailing Address - Fax:
Practice Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6710
Practice Address - Country:US
Practice Address - Phone:509-619-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH608989157101YM0800X
WA101YM0800X103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical