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General NPI Number Information
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NPI Number | 1255885794
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Entity Type | Individual
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Provider Name | KIRA JEAN BURGESS-ELMER LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2016
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Last Update Date | 12/02/2018
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Provider Practice Location Address
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Address Line | 1105 2ND ST S STE 100
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City | NAMPA
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State | ID
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Zip | 83651-3911
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Country | US
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Telephone | 208-488-2557
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 527
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City | NAMPA
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State | ID
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Zip | 83653-0527
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Country | US
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Telephone | 208-488-2557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-6287
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License Number State | ID
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