Provider Demographics
NPI:1932247632
Name:KEYS, KIMBERLY R (LCPC, CS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:KEYS
Suffix:
Gender:F
Credentials:LCPC, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4754101Y00000X
ID1141008101YA0400X
ID5497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)