Provider Demographics
NPI:1851450621
Name:KELLY, LOUISE (LMHC, CDP, LPC)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMHC, CDP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7933 BITTERN CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5504
Mailing Address - Country:US
Mailing Address - Phone:360-359-2473
Mailing Address - Fax:
Practice Address - Street 1:7933 BITTERN CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-5504
Practice Address - Country:US
Practice Address - Phone:360-359-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00009168101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00008542OtherLMHC
WACDPOtherCHEMICAL DEPENDENCY PROFE