Provider Demographics
NPI:1861080731
Name:WILLIAMS, KELSEY MARIE (COUNSELOR ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COUNSELOR ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 N LOMBARD ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4565
Mailing Address - Country:US
Mailing Address - Phone:971-704-9269
Mailing Address - Fax:
Practice Address - Street 1:4784 N LOMBARD ST.
Practice Address - Street 2:SUITE B PMB 1064
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4565
Practice Address - Country:US
Practice Address - Phone:971-704-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR10523OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS