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General NPI Number Information
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NPI Number | 1407634025
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Entity Type | Individual
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Provider Name | KELSEY WOOD LPC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1620 NORTHWEST BLVD STE 201
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2488
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Country | US
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Telephone | 208-254-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N COUNTRY LN
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2002
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Country | US
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Telephone | 208-582-0432
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9864
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9864
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9864
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License Number State | ID
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