Provider Demographics
NPI:1740570704
Name:ADAMS, KEELY E (LCPC)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:E
Other - Last Name:COVERDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:8100 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9057
Mailing Address - Country:US
Mailing Address - Phone:208-908-6399
Mailing Address - Fax:
Practice Address - Street 1:8100 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-908-6399
Practice Address - Fax:866-275-9883
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6157101YM0800X, 101YP2500X
VA0701004888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871542340Medicaid