Provider Demographics
NPI:1649981440
Name:DAVIS, KELSINGTEN P
Entity type:Individual
Prefix:
First Name:KELSINGTEN
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 NE 7TH AVE STE C116
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4528
Mailing Address - Country:US
Mailing Address - Phone:360-571-2432
Mailing Address - Fax:
Practice Address - Street 1:1210 W 25TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2373
Practice Address - Country:US
Practice Address - Phone:951-500-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician