Healthcare Provider Details

I. General information

NPI: 1932029303
Provider Name (Legal Business Name): MAGIC VALLEY BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DR
TWIN FALLS ID
83301-7441
US

IV. Provider business mailing address

493 EASTLAND DR
TWIN FALLS ID
83301-7441
US

V. Phone/Fax

Practice location:
  • Phone: 208-494-6824
  • Fax: 208-358-9068
Mailing address:
  • Phone: 208-494-6824
  • Fax: 208-358-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. KELSIE HENDRICKSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD, ABPP
Phone: 208-494-6824