Provider Demographics
NPI:1730216912
Name:ROBINSON, KELSIE LYN (MED, LCPC)
Entity type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:LYN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E 2200 N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0625
Mailing Address - Country:US
Mailing Address - Phone:208-308-5682
Mailing Address - Fax:
Practice Address - Street 1:220 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6312
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional