Provider Demographics
NPI:1760252076
Name:KELLEMEN, ANDROMEDA LITTRELL
Entity Type:Individual
Prefix:
First Name:ANDROMEDA
Middle Name:LITTRELL
Last Name:KELLEMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:LITTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28115 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8211
Mailing Address - Country:US
Mailing Address - Phone:360-460-7367
Mailing Address - Fax:
Practice Address - Street 1:3430 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2292
Practice Address - Country:US
Practice Address - Phone:253-289-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health