Healthcare Provider Details

I. General information

NPI: 1487503850
Provider Name (Legal Business Name): SHELLY D SANDERS LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 W GRENOBLE LN
COEUR D ALENE ID
83815-0481
US

IV. Provider business mailing address

2454 W GRENOBLE LN
COEUR D ALENE ID
83815-0481
US

V. Phone/Fax

Practice location:
  • Phone: 208-964-2113
  • Fax: 208-964-2113
Mailing address:
  • Phone: 208-964-2113
  • Fax: 208-964-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHELLY D SANDERS
Title or Position: OWNER, LCSW
Credential: SANDERS
Phone: 208-964-2113