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General NPI Number Information
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NPI Number | 1619031390
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Entity Type | Individual
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Provider Name | KEVIN JOSEPH KERVICK MS
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 109 W HONEYSUCKLE AVE UNIT 3414
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City | HAYDEN
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State | ID
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Zip | 83835-9910
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Country | US
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Telephone | 603-897-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W HONEYSUCKLE AVE UNIT 3414
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City | HAYDEN
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State | ID
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Zip | 83835-9910
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Country | US
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Telephone | 603-897-5504
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-8157
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 8187
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License Number State | ID
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