Organization
KELLY COMPANIES, LLC
Active
Parent organization
KELLY COMPANIES, LLC
Other names
Mountain Valley Counseling & Outdoor Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
KELLY COMPANIES, LLC
Authorized official
MRS. JAMIE TISA COFFEY-KELLY LCSW (PRESIDENT/CEO)
(208) 880-8727
Entity
Organization
Contact information
Practice address
13019 PONDEROSA DR, DONNELLY, ID 83615
(208) 880-8727
Mailing address
PO BOX 416, DONNELLY, ID 83615-0416
(208) 880-8727
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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