Healthcare Provider Details

I. General information

NPI: 1700742012
Provider Name (Legal Business Name): M MINSHALL LCPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 MOONRIDGE DRIVE
MCCALL ID
83638
US

IV. Provider business mailing address

PO BOX 4103
MCCALL ID
83638-8103
US

V. Phone/Fax

Practice location:
  • Phone: 208-630-3726
  • Fax:
Mailing address:
  • Phone: 208-630-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN E MINSHALL
Title or Position: OWNER
Credential: LCPC
Phone: 208-630-3726