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Organization

KELLEY KIDS RANCH, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMY T KELLEY (OWNER)
(208) 675-7350
Entity
Organization

Contact information

Practice address
602 13TH ST, LEWISTON, ID 83501-2586
(208) 675-7350
Mailing address
1607 17TH AVE, LEWISTON, ID 83501-4001

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
08/01/2019
Last updated
08/01/2019
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