Provider Demographics
NPI:1235011941
Name:WILLIAMS, KORTNIE RAE (QMHA)
Entity type:Individual
Prefix:MS
First Name:KORTNIE
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 W TELFAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4005
Mailing Address - Country:US
Mailing Address - Phone:971-481-4444
Mailing Address - Fax:
Practice Address - Street 1:9820 W TELFAIR DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4005
Practice Address - Country:US
Practice Address - Phone:971-481-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
ORT-22-148101YA0400X
OR22-CRM-921175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist