Provider Demographics
NPI:1255116414
Name:KELLY, LIAM M (MSW, LISWAIC)
Entity type:Individual
Prefix:MR
First Name:LIAM
Middle Name:M
Last Name:KELLY
Suffix:
Gender:M
Credentials:MSW, LISWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5295
Mailing Address - Country:US
Mailing Address - Phone:253-225-7920
Mailing Address - Fax:
Practice Address - Street 1:WEST REGUS BUILDING, 22722 29TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:253-225-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC613689911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical