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1386103224

NPI Code Detail

MEDICARE: KIM KEYS, LLC

MEDICARE: KIM KEYS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9198	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
2	LCPC-401	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
3	6488	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
4	7806	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
5	7285	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
6	7468	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
7	9602	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
8	LCPC-3851	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
9	40070	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
10	40369	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
11	8006	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
12	39596	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
13	LCPC-5497	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
14	LPC-5985	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
15	9364	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES
16	9565	OTHER	ID	IDAHO BOARD OF OCCUPATIONAL LICENSES

General Provider Information

NPI Number	:	1386103224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM KEYS, LLC

Provider Business Mailing Address
First Line	:	3050 N LAKEHARBOR LN STE 248
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6281
Country	:	US
Telephone Number	:	208-991-4696
Fax Number	:	208-902-3728

Provider Business Practice Location Address
First Line	:	3050 N LAKEHARBOR LN STE 248
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6281
Country	:	US
Telephone Number	:	208-991-4696
Fax Number	:	208-902-3728

Authorized Official
Title or Position	:	OWNER
Name	:	KIM KEYS
Credential	:	LCPC
Telephone Number	:	208-991-4696

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	01/08/2024

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Directions to “KIM KEYS, LLC ” Practice Location

Language	Start Address	Practice Location

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