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General NPI Number Information
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NPI Number | 1447658828
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Entity Type | Individual
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Provider Name | SHANE ALAN THOMASON LCPC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 2596 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-6114
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Country | US
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Telephone | 208-918-1636
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Fax |
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Provider Business Mailing Address
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Address Line | 5434 N ISLA AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-5852
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Country | US
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Telephone | 208-405-9165
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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 | LPC-5755
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License Number State | ID
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