Provider Demographics
NPI:1568847671
Name:PIERCE, KELSEY KATHLEEN (MCOUN, LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:KATHLEEN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MCOUN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3312
Mailing Address - Country:US
Mailing Address - Phone:208-234-4722
Mailing Address - Fax:208-234-2135
Practice Address - Street 1:110 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3312
Practice Address - Country:US
Practice Address - Phone:208-234-4722
Practice Address - Fax:208-234-2135
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5977101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-5977OtherSTATE LPC NUMBER