Provider Demographics
NPI:1891162061
Name:KOHLWES, KELLEY (MA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:KOHLWES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1102 A ST STE 426
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5011
Mailing Address - Country:US
Mailing Address - Phone:253-260-5167
Mailing Address - Fax:
Practice Address - Street 1:1102 A ST STE 426
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5011
Practice Address - Country:US
Practice Address - Phone:253-260-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60893898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist