Provider Demographics
NPI:1205056165
Name:KELLEY, SHARON A (MA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:A
Last Name:KELLEY
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 1:8712 1ST PL NE
Mailing Address - Street 2:STE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-4914
Mailing Address - Country:US
Mailing Address - Phone:425-314-3333
Mailing Address - Fax:
Practice Address - Street 1:1918 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3607
Practice Address - Country:US
Practice Address - Phone:425-257-2111
Practice Address - Fax:425-339-1704
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health