Provider Demographics
NPI:1326421520
Name:WOODBURN, KELSI (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 S 10TH AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6816
Mailing Address - Country:US
Mailing Address - Phone:208-454-2766
Mailing Address - Fax:208-454-2726
Practice Address - Street 1:2609 S 10TH AVE
Practice Address - Street 2:STE. 102
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6816
Practice Address - Country:US
Practice Address - Phone:208-454-2766
Practice Address - Fax:208-454-2726
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional