Individual
KELLIE HUMPHERYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6933 W EMERALD ST, BOISE, ID 83704-8616
(208) 321-0634
(208) 321-1082
Mailing address
6933 W EMERALD ST, BOISE, ID 83704-8616
(208) 321-0634
(208) 321-1082
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-37609
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002803300
—
ID
Enumeration date
05/20/2008
Last updated
12/17/2025
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