Individual
KELLI TILLQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1529 W BELMONT ST, BOISE, ID 83725-2336
(208) 426-2987
Mailing address
PO BOX 45056, BOISE, ID 83711-5056
(208) 859-1906
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
203634
ID
103TC0700X
Clinical Psychologist
PSY-203634
ID
Other
Enumeration date
07/08/2019
Last updated
08/08/2025
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