Provider Demographics
NPI:1467675686
Name:KEARNEY, JOYCE (LMFT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20270 N SHEPHERDS PIE WAY
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1719
Mailing Address - Country:US
Mailing Address - Phone:208-391-2913
Mailing Address - Fax:
Practice Address - Street 1:690 S INDUSTRY WAY STE 45
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7907
Practice Address - Country:US
Practice Address - Phone:208-291-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7291106H00000X
CA96309106H00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN238713OtherCOMPSYCH INS PROVIDER ID