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NPI Code Detail

MEDICARE: JOE ALAN SHABER LCPC

MEDICARE: JOE ALAN SHABER LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLCPC-5196ID
2101YM0800XMental Health CounselorLCPC-5196ID

General Provider Information

NPI Number : 1851699193
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOE ALAN SHABER LCPC
Provider Business Mailing Address
First Line : 83 S CANYON
Second Line :
City : NAMPA
State : ID
Zip : 83651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 320 11TH AVE S STE 204
Second Line :
City : NAMPA
State : ID
Zip : 83651-5074
Country : US
Telephone Number : 208-724-3594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 11/27/2023

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