Individual
MRS. JAMIE TISA COFFEY-KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
402 LAKE CASCADE PKWY, CASCADE, ID 83611-7702
(208) 382-4285
(208) 382-5081
Mailing address
PO BOX 1330, CASCADE, ID 83611-1330
(208) 382-4285
(208) 382-5081
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-37639
ID
Other
Enumeration date
11/13/2013
Last updated
02/22/2021
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