Provider Demographics
NPI:1942618814
Name:WINTER, KELLY (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:WINTER WELLNESS
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2032 NW GREENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8813
Mailing Address - Country:US
Mailing Address - Phone:559-972-0096
Mailing Address - Fax:
Practice Address - Street 1:376 SW BLUFF DR STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1399
Practice Address - Country:US
Practice Address - Phone:559-462-0161
Practice Address - Fax:866-461-6780
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT106906106H00000X
ORT1477106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist