Provider Demographics
NPI:1861840639
Name:FURNISS, KELSEY KAE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:KAE
Last Name:FURNISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:KAE
Other - Last Name:HAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1805 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3508
Mailing Address - Country:US
Mailing Address - Phone:208-869-0743
Mailing Address - Fax:
Practice Address - Street 1:1805 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3508
Practice Address - Country:US
Practice Address - Phone:208-869-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker