Healthcare Provider Details

I. General information

NPI: 1184968091
Provider Name (Legal Business Name): SHAYNE M. AGUIRRE LPC, NCC, QSUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 W COLLEGE AVE
SAINT MARIES ID
83861-5010
US

IV. Provider business mailing address

PO BOX 266
FERNWOOD ID
83830-0266
US

V. Phone/Fax

Practice location:
  • Phone: 208-680-9042
  • Fax: 877-471-2556
Mailing address:
  • Phone: 208-568-1398
  • Fax: 877-471-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC-4990
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-4990
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-4990
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: