Provider Demographics
NPI:1972042299
Name:THREADGILL, KARI (MA, LMHCA, LPC, CMHS)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:MA, LMHCA, LPC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 W DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 NORTHWEST BLVD STE 107A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2971
Practice Address - Country:US
Practice Address - Phone:208-449-1272
Practice Address - Fax:208-209-7427
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60590024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health