Provider Demographics
NPI:1356656441
Name:MCMURTREY, KELLY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:MCMURTREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 E 214 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5410
Mailing Address - Country:US
Mailing Address - Phone:208-351-7827
Mailing Address - Fax:
Practice Address - Street 1:1465 HOOPES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5772
Practice Address - Country:US
Practice Address - Phone:208-522-5545
Practice Address - Fax:208-528-6773
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-341451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical