Provider Demographics
NPI:1073759049
Name:MATIAS, KIMBERLY REED (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:REED
Last Name:MATIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W HAYS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5511
Mailing Address - Country:US
Mailing Address - Phone:208-381-7070
Mailing Address - Fax:208-381-7092
Practice Address - Street 1:610 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5511
Practice Address - Country:US
Practice Address - Phone:208-381-7070
Practice Address - Fax:208-381-7092
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-33136104100000X
IDLMSW-29187101Y00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor