Provider Demographics
NPI:1508006362
Name:RUNDLE, KELLY LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:RUNDLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2044
Mailing Address - Country:US
Mailing Address - Phone:425-269-5423
Mailing Address - Fax:425-823-2284
Practice Address - Street 1:620 KIRKLAND WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-889-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006382101YA0400X
WALH00005229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)