Healthcare Provider Details

I. General information

NPI: 1902567605
Provider Name (Legal Business Name): SHELBY ANN SPANGLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date: 01/12/2022
Reactivation Date: 02/17/2022

III. Provider practice location address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

IV. Provider business mailing address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

V. Phone/Fax

Practice location:
  • Phone: 208-477-7291
  • Fax:
Mailing address:
  • Phone: 208-477-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8503
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-8503
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: