Provider Demographics
NPI:1285803619
Name:BARNES, KELLI A (MA, NCC, LCPC-S)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:BARNES
Suffix:
Gender:F
Credentials:MA, NCC, LCPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 S COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0932
Mailing Address - Country:US
Mailing Address - Phone:208-683-8320
Mailing Address - Fax:208-969-8380
Practice Address - Street 1:148 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0932
Practice Address - Country:US
Practice Address - Phone:208-683-8320
Practice Address - Fax:208-969-8380
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC5276101YM0800X
ID7518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health