Provider Demographics
NPI:1740767284
Name:LOY, KELLY (LMFT, LCPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOY
Suffix:
Gender:F
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E. RIVERPARK LANE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-398-3308
Mailing Address - Fax:
Practice Address - Street 1:671 E. RIVERPARK LANE, SUITE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-398-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6929101YP2500X
IDLPC6929101YP2500X
ID6929101YP2500X
IDLCPC-8075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional