Provider Demographics
NPI:1174928147
Name:KAY, KATHY (COUNSELOR)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 RIVER RD N
Mailing Address - Street 2:STE 141
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5098
Mailing Address - Country:US
Mailing Address - Phone:503-510-9154
Mailing Address - Fax:503-510-9154
Practice Address - Street 1:3785 RIVER RD N
Practice Address - Street 2:STE 141
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5098
Practice Address - Country:US
Practice Address - Phone:503-510-9154
Practice Address - Fax:503-510-9154
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor