Provider Demographics
NPI:1437574142
Name:NEWHOUSE, KELLY D
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:B
Other - Last Name:DEWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4309
Mailing Address - Country:US
Mailing Address - Phone:360-504-4430
Mailing Address - Fax:
Practice Address - Street 1:1225 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4309
Practice Address - Country:US
Practice Address - Phone:360-504-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60962152101YM0800X, 101YM0800X
NC11228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health