Provider Demographics
NPI:1649261538
Name:WRIGHT, KELLI L (LCSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:WRIGHT
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 1:6488 CHINOOK ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-7515
Mailing Address - Country:US
Mailing Address - Phone:208-267-8710
Mailing Address - Fax:208-267-8719
Practice Address - Street 1:6488 CHINOOK ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7515
Practice Address - Country:US
Practice Address - Phone:208-267-8710
Practice Address - Fax:208-267-8719
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-27372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806590100Medicaid
ID806590100Medicaid
ID13-1822Medicare Oscar/Certification
ID1693450Medicare ID - Type UnspecifiedPART B