# KELLEY KIDS RANCH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134774680
- **Authorized official:** AMY T THOMAS LCSW (OWNER)
- **Authorized official phone:** (208) 675-7350

## Contact information

- **Practice address:** 514 THAIN RD STE B, LEWISTON, ID 83501-5533
- **Practice address phone:** (208) 413-7353
- **Practice address fax:** (208) 413-7338
- **Mailing address:** 514 THAIN RD STE B, LEWISTON, ID 83501-5533
- **Mailing address phone:** (208) 413-7353
- **Mailing address fax:** (208) 413-7338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 08/01/2019
- **Last updated:** 07/20/2026