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General NPI Number Information
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NPI Number | 1043737091
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Entity Type | Individual
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Provider Name | DORI A SHANER LPC
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Gender | Female
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 6684 S LIVEOAK PL
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City | BOISE
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State | ID
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Zip | 83716-5047
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Country | US
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Telephone | 208-409-4961
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Fax |
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Provider Business Mailing Address
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Address Line | 6684 S LIVEOAK PL
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City | BOISE
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State | ID
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Zip | 83716-5047
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Country | US
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Telephone | 208-409-4961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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