Provider Demographics
NPI:1871654798
Name:CHRISTY KELSHAW
Entity Type:Organization
Organization Name:CHRISTY KELSHAW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MACOUN, LCPC
Authorized Official - Phone:208-478-4642
Mailing Address - Street 1:845 W CENTER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4205
Mailing Address - Country:US
Mailing Address - Phone:208-478-4642
Mailing Address - Fax:208-232-8001
Practice Address - Street 1:845 W CENTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4205
Practice Address - Country:US
Practice Address - Phone:208-478-4642
Practice Address - Fax:208-232-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty