MEDICARE: MISS LINDSAY RAE KENLEY NCC, LPC

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	LPC-6220	ID
2	101YM0800X	Mental Health Counselor	LCPC-7112	ID

General Provider Information

NPI Number	:	1831643154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LINDSAY RAE KENLEY NCC, LPC

Provider Business Mailing Address
First Line	:	2491 N DEVLIN AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5091
Country	:	US
Telephone Number	:	208-298-9886
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 E RIVERSIDE DR STE 120
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6585
Country	:	US
Telephone Number	:	208-298-9886
Fax Number	:

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

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	08/03/2023

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