Provider Demographics
NPI:1720749658
Name:OBERBILLIG, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:OBERBILLIG
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 1:3618 BAGLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9133
Mailing Address - Country:US
Mailing Address - Phone:253-486-2625
Mailing Address - Fax:
Practice Address - Street 1:15315 1ST AVE NE STE 216
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-5005
Practice Address - Country:US
Practice Address - Phone:425-780-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health