Provider Demographics
NPI:1568826204
Name:NEWTON, KELSY (PSYD)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7034 W HUMMEL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1938
Mailing Address - Country:US
Mailing Address - Phone:208-917-2439
Mailing Address - Fax:
Practice Address - Street 1:7034 W HUMMEL DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1938
Practice Address - Country:US
Practice Address - Phone:208-917-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-203181103TC2200X
ID203181103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent