Individual
KELLY JAVIN DON MATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LCPC
Contact information
Practice address
104 9TH AVE S STE B1, NAMPA, ID 83651-3852
(208) 495-5806
(208) 606-3680
Mailing address
104 9TH AVE S STE B1, NAMPA, ID 83651-3852
(208) 495-5806
(208) 606-3680
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6836
ID
Other
Enumeration date
04/19/2012
Last updated
03/20/2025
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