Doctor Name: | KELLY JAVIN DON MATHER |
NPI Number: | 1952668683 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C. |
License Number: | 4859 |
Business Practice Address: | 112 12th Ave Rd Nampa, ID - 836865011 |
Business Phone Number: | 2084655433 |
Business Fax Number: | |
Mailing Address: | 1481 E Sharons Loop, #101 NAMPA |
State: | ID |
Postal Code: | 836866076 |
Phone Number: | 2086609655 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2012 |
NPI Last Update Date: | 05/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 4859 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |