Healthcare Provider Details

I. General information

NPI: 1689502809
Provider Name (Legal Business Name): KILEY ALVAREZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S LATAH ST STE 106
BOISE ID
83705-1501
US

IV. Provider business mailing address

3554 S ROSA PARKS WAY
NAMPA ID
83686-3910
US

V. Phone/Fax

Practice location:
  • Phone: 208-297-3361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1081116
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: