Healthcare Provider Details

I. General information

NPI: 1417211988
Provider Name (Legal Business Name): KIMBERLY ANN TURNBLOM MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W HAYS ST
BOISE ID
83702-5025
US

IV. Provider business mailing address

7227 W POTOMAC DR
BOISE ID
83704-9150
US

V. Phone/Fax

Practice location:
  • Phone: 208-803-5339
  • Fax:
Mailing address:
  • Phone: 208-284-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 4919
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 6325
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: