Provider Demographics
NPI:1871720177
Name:KELLY, DIANE CLAIRE (LMHC,)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CLAIRE
Last Name:KELLY
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 1:225 NW LINDVIG WAY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6520
Mailing Address - Country:US
Mailing Address - Phone:360-379-2830
Mailing Address - Fax:
Practice Address - Street 1:225 NW LINDVIG WAY
Practice Address - Street 2:SUITE 10
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6520
Practice Address - Country:US
Practice Address - Phone:360-379-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health