Provider Demographics
NPI:1811256852
Name:HILL, WILLIAM KELLY (LCPC-5873)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KELLY
Last Name:HILL
Suffix:
Gender:M
Credentials:LCPC-5873
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:KELLY
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1972 E GLENLOCH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5786
Mailing Address - Country:US
Mailing Address - Phone:208-995-5329
Mailing Address - Fax:
Practice Address - Street 1:2770 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5953
Practice Address - Country:US
Practice Address - Phone:208-738-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4984101YM0800X
IDLCPC-5873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1265565477Medicaid