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General NPI Number Information
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NPI Number | 1487310074
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Entity Type | Organization
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Legal Business Name | KELLY COMPANIES, LLC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 13019 PONDEROSA DR
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City | DONNELLY
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State | ID
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Zip | 83615
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Country | US
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Telephone | 208-880-8727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 416
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City | DONNELLY
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State | ID
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Zip | 83615-0416
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Country | US
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Telephone | 208-880-8727
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. JAMIE TISA COFFEY-KELLY
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Credential | LCSW
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Telephone | 208-880-8727
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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 |
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License Number State |
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