Active NPI
Kiley K Gallentine, PSYD
- Mental Health Counselor
- Pacific, WA
National Provider Identifier
1669837621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC60619294
- Practice address
- 413 Wayne Ave SE
Pacific, WA 98047-1453 - Phone
- (206) 240-8396
- NPI assigned
- Dec 17, 2015
- Last updated
- Dec 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC60619294 | WA | Primary |
Addresses
Primary practice location
413 Wayne Ave SE
Pacific, WA 98047-1453
Mailing address
413 Wayne Ave SE
Pacific, WA 98047-1453
Phone (206) 240-8396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC60619294 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1669837621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 WAYNE AVE SE",
"city": "PACIFIC",
"state": "WA",
"postal_code": "980471453",
"telephone_number": "206-240-8396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 WAYNE AVE SE",
"city": "PACIFIC",
"state": "WA",
"postal_code": "980471453",
"telephone_number": "206-240-8396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLENTINE",
"first_name": "KILEY",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-17",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC60619294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pacific, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.