Provider Demographics
NPI:1427565100
Name:GULLEY, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GULLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 W HIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4106
Mailing Address - Country:US
Mailing Address - Phone:208-608-1233
Mailing Address - Fax:
Practice Address - Street 1:824 17TH AVE S STE 7
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4781
Practice Address - Country:US
Practice Address - Phone:208-608-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8321720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health