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General NPI Number Information
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NPI Number | 1356737795
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Entity Type | Individual
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Provider Name | SPENCER KELSEY LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 980 BURLEY AVE
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City | BUHL
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State | ID
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Zip | 83316-1849
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Country | US
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Telephone | 208-814-9150
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Fax | 208-814-9151
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-8866
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-31119
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6155-C
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License Number State | NV
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