Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | RC00054980 | WA |
NPI | 1003016056 |
---|---|
Provider Name | Kelli J George |
First Address | Spokane, WA 99201-2831 |
Second Address | Spokane, WA 99201-2831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |