Provider Demographics
NPI:1598206005
Name:SMOTHERS, KELLY (LPC, ICADC,SAP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:LPC, ICADC,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 GOODING ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6178
Mailing Address - Country:US
Mailing Address - Phone:208-293-8846
Mailing Address - Fax:208-595-2542
Practice Address - Street 1:219 GOODING ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6178
Practice Address - Country:US
Practice Address - Phone:208-293-8846
Practice Address - Fax:208-595-2542
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6156101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)