Kelly Companies, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KELLY COMPANIES, LLC

Practice address

13019 Ponderosa Dr
Donnelly, ID 83615

Phone

(208) 880-8727

NPI assigned

Nov 9, 2021

Organization subpart

Yes

Parent organization

KELLY COMPANIES, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jamie Tisa Coffey-Kelly, LCSWNPI 1992135818

Title

President/Ceo

Phone

(208) 880-8727

Specialties & licenses 1

Addresses

Other names 1

• Mountain Valley Counseling & Outdoor Therapy Doing business as

Part of

Kelly Companies LLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamie Tisa Coffey-Kelly, LCSW

  • Clinical Social Worker
  • Cascade, ID
  • NPI 1992135818

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1487310074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416",
            "city": "DONNELLY",
            "state": "ID",
            "postal_code": "836150416",
            "telephone_number": "208-880-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13019 PONDEROSA DR",
            "city": "DONNELLY",
            "state": "ID",
            "postal_code": "83615",
            "telephone_number": "208-880-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY COMPANIES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELLY COMPANIES, LLC",
        "enumeration_date": "2021-11-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "COFFEY-KELLY",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "TISA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "208-880-8727",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Valley Counseling & Outdoor Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Donnelly, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.