Active NPI
Kristen Connolly, LPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1861241143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10495
- Practice address
- 4696 West Overland Rd
Ste 132
Boise, ID 83705-2845 - Phone
- (208) 994-5662
- NPI assigned
- May 17, 2024
- Last updated
- Jan 15, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 10495 | ID | Primary |
Addresses
Primary practice location
4696 West Overland Rd
Ste 132
Boise, ID 83705-2845
Mailing address
4696 West Overland Rd
Ste 132
Boise, ID 83705-2845
Phone (208) 994-5662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10495 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736899200000",
"number": "1861241143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4696 WEST OVERLAND RD",
"address_2": "STE 132",
"city": "BOISE",
"state": "ID",
"postal_code": "837052845",
"telephone_number": "208-994-5662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4696 WEST OVERLAND RD",
"address_2": "STE 132",
"city": "BOISE",
"state": "ID",
"postal_code": "837052845",
"telephone_number": "208-994-5662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "KRISTEN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-17",
"last_updated": "2025-01-15",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "10495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.