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General NPI Number Information
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NPI Number | 1457831786
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Entity Type | Organization
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Legal Business Name | KBE BEHAVIORAL HEALTH & FORENSIC SERVICES, LLC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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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 | 208-498-6305
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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 | 208-498-6305
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Authorized Official
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Title or Position | OWNER
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Name | KIRA JEAN BURGESS-ELMER
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Credential | LCPC
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Telephone | 208-488-2557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCPC-6287
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License Number State | ID
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