MEDICARE: KELLY CATANIA LAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LAMFT-10083	ID

General Provider Information

NPI Number	:	1295145589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CATANIA LAMFT

Provider Business Mailing Address
First Line	:	3676 N HARBOR LN STE 100
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6919
Country	:	US
Telephone Number	:	208-607-3503
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 NE SHAVER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1050
Country	:	US
Telephone Number	:	503-875-6345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	04/16/2024

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