Provider Demographics
NPI:1770329807
Name:ZACAPU, KELSEY LAUREN (LMSW, ADC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LAUREN
Last Name:ZACAPU
Suffix:
Gender:
Credentials:LMSW, ADC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LAUREN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3245 E MOSSY ROCK CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-3043
Mailing Address - Country:US
Mailing Address - Phone:360-218-9511
Mailing Address - Fax:
Practice Address - Street 1:709 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4116
Practice Address - Country:US
Practice Address - Phone:208-376-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC-5077101YA0400X
ID4471144104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)