Provider Demographics
NPI:1831516590
Name:JIANAS, KELLY (LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JIANAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 17TH ST STE 111A
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8046
Mailing Address - Country:US
Mailing Address - Phone:208-557-1517
Mailing Address - Fax:
Practice Address - Street 1:1970 E 17TH ST STE 111A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8046
Practice Address - Country:US
Practice Address - Phone:208-557-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist