Individual
KELLIE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW-INTERN
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7580
Mailing address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7580
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
IC-1164
NV
Other
Enumeration date
12/12/2017
Last updated
07/12/2023
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