Individual
DR. KELLY PETRINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
3350 W AMERICANA TER STE 210, BOISE, ID 83706-2546
(406) 880-5568
Mailing address
3883 S COMO AVE, MERIDIAN, ID 83642-1446
(406) 880-5568
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
18071
MT
103T00000X
Psychologist
505
WY
103TC0700X
Clinical Psychologist
Primary
203518
ID
Other
Enumeration date
05/05/2011
Last updated
05/11/2022
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