Provider Demographics
NPI:1548045636
Name:MARPLE, KELSEY L (MA, NCC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:MARPLE
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 SW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2717
Mailing Address - Country:US
Mailing Address - Phone:503-702-2661
Mailing Address - Fax:
Practice Address - Street 1:533 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5840
Practice Address - Country:US
Practice Address - Phone:971-258-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health