MEDICARE: MRS. KASEY MARIE ABERCROMBIE MA LCPC

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	LCPC-6410	ID
2	101YM0800X	Mental Health Counselor	LPC-24300	AZ

General Provider Information

NPI Number	:	1760799605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KASEY MARIE ABERCROMBIE MA LCPC

Provider Business Mailing Address
First Line	:	200 N HIGHBROOK WAY
Second Line	:	SUITE 106 PMB 389
City	:	STAR
State	:	ID
Zip	:	83669
Country	:	US
Telephone Number	:	208-614-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 N WESTGATE DR STE 1A
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-7164
Country	:	US
Telephone Number	:	208-614-2949
Fax Number	:

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	10/09/2025

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