Provider Demographics
NPI:1184958795
Name:LYLES, KELLI (MA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LYLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 WEATHERS CT SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1756
Mailing Address - Country:US
Mailing Address - Phone:253-224-0509
Mailing Address - Fax:
Practice Address - Street 1:3974 WEATHERS CT SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1756
Practice Address - Country:US
Practice Address - Phone:253-224-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 174H00000X, 374J00000X, 171400000X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula