Provider Demographics
NPI:1912178310
Name:BOUNKEUA, PHOUKHAM KELLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHOUKHAM
Middle Name:KELLY
Last Name:BOUNKEUA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:P
Other - Middle Name:KELLY
Other - Last Name:BOUNKEUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMHC
Mailing Address - Street 1:16040 CHRISTENSEN ROAD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:206-431-5336
Mailing Address - Fax:206-431-5430
Practice Address - Street 1:16040 CHRISTENSEN ROAD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:425-391-0887
Practice Address - Fax:425-391-7014
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health