MEDICARE: KELLY EISENBARGER MSW

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		ID

General Provider Information

NPI Number	:	1568355691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY EISENBARGER MSW

Provider Business Mailing Address
First Line	:	PO BOX 533
Second Line	:
City	:	KETCHUM
State	:	ID
Zip	:	83340-0481
Country	:	US
Telephone Number	:	208-450-5645
Fax Number	:	208-247-4987

Provider Business Practice Location Address
First Line	:	250 W BOBWHITE CT STE 240
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-6656
Country	:	US
Telephone Number	:	208-450-5645
Fax Number	:	208-247-4987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	05/29/2025

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Directions to “ KELLY EISENBARGER MSW” Practice Location

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