Provider Demographics
NPI:1053095521
Name:KNIGHT-KING, KELSEY (LPCA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KNIGHT-KING
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SE 223RD AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2577
Mailing Address - Country:US
Mailing Address - Phone:503-836-8836
Mailing Address - Fax:
Practice Address - Street 1:8022 SE RHONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2365
Practice Address - Country:US
Practice Address - Phone:503-505-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional