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NPI Code Detail

MEDICARE: KELLY SMOTHERS LPC, ICADC,SAP

MEDICARE: KELLY SMOTHERS LPC, ICADC,SAP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLPC-6156ID
2101YP2500XProfessional CounselorLPC-6156ID
3101YM0800XMental Health CounselorLPC-6156ID

General Provider Information

NPI Number : 1598206005
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SMOTHERS LPC, ICADC,SAP
Provider Business Mailing Address
First Line : 219 GOODING ST N
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-6178
Country : US
Telephone Number : 208-293-8846
Fax Number : 208-595-2542
Provider Business Practice Location Address
First Line : 219 GOODING ST N
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-6178
Country : US
Telephone Number : 208-293-8846
Fax Number : 208-595-2542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2017
Last Update Date : 03/02/2026

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