Provider Demographics
NPI:1386103224
Name:KIM KEYS, LLC
Entity type:Organization
Organization Name:KIM KEYS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-991-4696
Mailing Address - Street 1:3050 N LAKEHARBOR LN STE 248
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6281
Mailing Address - Country:US
Mailing Address - Phone:208-991-4696
Mailing Address - Fax:208-902-3728
Practice Address - Street 1:3050 N LAKEHARBOR LN STE 248
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6281
Practice Address - Country:US
Practice Address - Phone:208-991-4696
Practice Address - Fax:208-902-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID9198OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
IDLCPC-401OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID6488OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID7806OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID7285OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID7468OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID9602OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
IDLCPC-3851OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID40070OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID40369OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID8006OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID39596OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
IDLCPC-5497OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
IDLPC-5985OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID9364OtherIDAHO BOARD OF OCCUPATIONAL LICENSES
ID9565OtherIDAHO BOARD OF OCCUPATIONAL LICENSES