Provider Demographics
NPI:1831643154
Name:KENLEY, LINDSAY RAE (NCC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:LINDSAY
Middle Name:RAE
Last Name:KENLEY
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2491 N DEVLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5091
Mailing Address - Country:US
Mailing Address - Phone:208-298-9886
Mailing Address - Fax:
Practice Address - Street 1:533 E RIVERSIDE DR STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6585
Practice Address - Country:US
Practice Address - Phone:208-298-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6220101YM0800X
IDLCPC-7112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health