Provider Demographics
NPI:1427935147
Name:KIMBALL, GRAYSEN KEELEY
Entity type:Individual
Prefix:
First Name:GRAYSEN
Middle Name:KEELEY
Last Name:KIMBALL
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 1:10626 270TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8746
Mailing Address - Country:US
Mailing Address - Phone:253-355-9496
Mailing Address - Fax:
Practice Address - Street 1:313 YELM AVE W
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8036
Practice Address - Country:US
Practice Address - Phone:360-960-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health