Provider Demographics
NPI:1740570704
Name:ADAMS, KEELY ELISE (LCPC)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:ELISE
Last Name:ADAMS
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:ELISE
Other - Last Name:COVERDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4665 S ALMA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9168
Mailing Address - Country:US
Mailing Address - Phone:208-800-9599
Mailing Address - Fax:208-277-1817
Practice Address - Street 1:4665 S ALMA AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9168
Practice Address - Country:US
Practice Address - Phone:208-800-9599
Practice Address - Fax:208-277-1817
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6157101YP2500X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1740570704Medicaid