Provider Demographics
NPI:1457831786
Name:KBE BEHAVIORAL HEALTH & FORENSIC SERVICES, LLC
Entity Type:Organization
Organization Name:KBE BEHAVIORAL HEALTH & FORENSIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BURGESS-ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-488-2557
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0527
Mailing Address - Country:US
Mailing Address - Phone:208-488-2557
Mailing Address - Fax:208-498-6305
Practice Address - Street 1:1105 2ND ST S STE 100
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3911
Practice Address - Country:US
Practice Address - Phone:208-488-2557
Practice Address - Fax:208-498-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6287251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health