Healthcare Provider Details

I. General information

NPI: 1689068793
Provider Name (Legal Business Name): SHANNON HURD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N 4TH AVE
SANDPOINT ID
83864-1513
US

IV. Provider business mailing address

3761 LECLERC RD S
NEWPORT WA
99156-9166
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-5394
  • Fax:
Mailing address:
  • Phone: 208-263-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5498
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: